Round 1: Does Major Depressive Disorder (MDD) Lead to Postpartum Depression (PPD)?

In the first round of this debate, our participants addressed the question: Does MDD lead to PPD?

Transcript:

Dr Jennifer Payne: Welcome to Great Debates and Updates in Psychiatry, brought to you by Psych Congress Network. Let's get started on round one of this debate, where we will be discussing whether major depression leads to postpartum depression. Dr Barrett…

Dr Melanie Barrett: The DSM-5 includes a peripartum onset specifier for a major depressive episode, or that has an onset during pregnancy or within the first 4 weeks after delivery. Many women who develop PPD have had previous episodes of major depression, and we'll go on to have other episodes of depression outside the postpartum or perinatal.

Dr Jennifer Payne: We can think of major depression as a heterogeneous group of disorders with several different biological underpinnings that, in the setting of various environmental stressors, lead to what we clinically call major depression. Postpartum depression, also known as PPD, is one type of major depression that's likely to be more homogeneous from a biological and environmental perspective. This is because all women with PPD have gone through the specific biological changes of pregnancy and childbirth and the specific environmental stressors of becoming a parent. For example, I have biomarkers that are about 80% accurate in predicting who is at risk, meaning that we have a biological marker for about 80% of the cases of PPD that are biologically similar. That being said, it's clear that postpartum depression is strongly related to an increased risk of experiencing major depression outside of the perinatal time.

Dr Melanie Barrett: MDD is a recurrent disorder. Epidemiologic studies point to a history of mood or anxiety disorders prior to pregnancy as a strong predictor of perinatal depression in a large population-based study. The risk of PPD was 20 times higher in women with a history of depression compared to women without. There are women, however, whose first episode of depression occurs during pregnancy or in the postpartum. This does pose the question of whether these cases represent distinct conditions and if the timing of PPD onset matters.

Dr Jennifer Payne: Going back to research, our biomarkers are about 80% accurate. We think the biomarkers are a marker of sensitivity to the changes in estrogen that happen throughout pregnancy and delivery. About 20% of women who experience postpartum depression are biomarker negative, meaning they don't have the same sensitivity to changes in estrogen levels and that they have other biological factors that are driving the development of postpartum depression. This is unpublished, but we've been looking at the clinical phenotypes of biomarker-positive vs biomarker-negative postpartum depression. And interestingly, those women with biomarker-negative postpartum depression are more likely to have a history of major depression outside of the perinatal time. This may mean that although they are not sensitive to the hormonal changes, they are sensitive to times of significant stress, like the postpartum time. When one becomes apparent, this results in those women developing a major depressive episode that happens to be in the postpartum time because of the associated stress. They may have a very different underlying biological cause of their depression from those that are biomarker-positive. Thank you, Dr Barrett, for participating in this debate. Be sure to tell us who you think won this round by answering the poll questions you see on your screen, and be sure to join us next time for round two, where we will discuss whether postpartum depression leads to major depression.