Severe pregnancy-related depression may be rooted in inflammation

November 20, 2019

GRAND RAPIDS, Mich. (Nov. 20, 2019) -- A runaway, inflammatory immune response may be responsible for triggering severe depression during and after pregnancy, according to a new study published in the journal Brain, Behavior and Immunity.

Not to be mistaken for the rapidly passing "baby blues," which is common right after delivery, pregnancy-related depression is a serious medical condition that can escalate in severity and may even require hospitalization. One in five new mothers experience depression after pregnancy, with symptoms beginning during pregnancy and generally worsening after delivery. An estimated 14% have suicidal ideation during pregnancy.

"Pregnancy-related depression is common yet poorly understood," said Lena Brundin, M.D., Ph.D., an associate professor at Van Andel Institute and senior author of the study. "Biologically speaking, pregnancy is a major inflammatory event that can upend many of the body's day-to-day molecular processes. If we can better understand these irregularities, it could lead to new ideas about how best to treat perinatal depression."

The team, which included researchers from Pine Rest Christian Mental Health Services and Michigan State University, analyzed blood samples from 165 patient volunteers at Pine Rest's Mother and Baby Program and the Obstetrics and Gynecology Clinic at Spectrum Health in Grand Rapids.

They found that several inflammatory factors appear to contribute to pregnancy-related depression onset and severity. Levels of IL-6 and IL-8 -- both inflammatory chemicals called cytokines -- were elevated while levels of another cytokine called IL-2, which plays an important role in immune function, were low. At the same time, there was a drastic reduction in serotonin, an important chemical regulator of mood.

These changes point to alterations in the way a molecular building block called tryptophan, which is required for serotonin production, is hijacked and shunted away by the kynurenine pathway, a molecular cascade closely linked to inflammation. The resulting loss of serotonin tracks with depressive symptom intensity; the less serotonin, the more severe the symptoms.

"Inflammation is an important and normal part of the immune system and, in early pregnancy, prevents the mother's immune system from attacking the fetus. However, when the inflammatory reaction is protracted or more intense than is optimal, it may lead to worsening depression in a subset of vulnerable women," said Eric Achtyes, M.D., M.S., staff psychiatrist at Pine Rest, an associate professor at Michigan State and the study's lead author. "Hopefully, this study will allow us to develop treatments that more specifically target those who are at risk for an 'inflammatory' perinatal depression."
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In addition to Brundin and Achtyes, authors include Sarah A. Keaton, Ph.D., Amanda R. Burmeister, Ph.D., Patrick L. Heilman, Ph.D., Stanislaw Krzyzanowski and Martha L. Escobar Galvis, Ph.D. of Van Andel Institute; LeAnn Smart and Madhavi Nagalla, M.D., of Pine Rest Christian Mental Health Services; Gilles J. Guillemin, Ph.D., and Chai K. Lim, Ph.D., of Macquarie University; Maria Muzik, M.D., of University of Michigan; Teodor T. Postolache, M.D., Ph.D., of University of Maryland School of Medicine; and Richard Leach, M.D., of Michigan State University. Achtyes, Nagalla and Keaton also are affiliated with Michigan State University; Leach also is affiliated with Spectrum Health. Van Andel Institute's Pathology and Biorepository Core and Bioinformatics and Biostatistics Core also contributed to this study.

The confidential National Suicide Prevention Lifeline is free and available 24/7 at 1-800-273-TALK (8255).

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award no. R01MH104622 (Brundin). The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding organization.

ABOUT VAN ANDEL INSTITUTE

Van Andel Institute (VAI) is committed to improving the health and enhancing the lives of current and future generations through cutting edge biomedical research and innovative educational offerings. Established in Grand Rapids, Michigan, in 1996 by the Van Andel family, VAI is now home to more than 400 scientists, educators and support staff, who work with a growing number of national and international collaborators to foster discovery. The Institute's scientists study the origins of cancer, Parkinson's and other diseases and translate their findings into breakthrough prevention and treatment strategies. Our educators develop inquiry-based approaches for K-12 education to help students and teachers prepare the next generation of problem-solvers, while our Graduate School offers a rigorous, research-intensive Ph.D. program in molecular and cellular biology. Learn more at vai.org.

ABOUT PINE REST CHRISTIAN MENTAL HEALTH SERVICES

Pine Rest, the fourth largest behavioral health provider in the U.S., has been the preeminent partner in West Michigan for decades. It is the proven leader in behavioral health services in the region. It offers a full continuum of services including inpatient and partial hospitalization, psychiatric urgent care, residential and outpatient services, addiction treatment and recovery, extensive child and adolescent programs, senior care services, as well as specialized assessment and treatment clinics. In addition to the main campus in Grand Rapids, Pine Rest also has 19 outpatient locations throughout West Michigan and Iowa plus offers teletherapy and telepsychiatry. It is the most qualified to serve local behavioral health care needs. For more information, go to http://www.pinerest.org.

Van Andel Research Institute

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