Abstract
Background: Within three to six months after delivery, 13%–19% of women suffer from post-partum depression (PPD), understood as a dysfunctional adaptation to the postpartum condition and motherhood. In the present cross-sectional study, we compared the hair steroid levels of women 12 weeks before and after delivery and with or without PPD. Method: The present study was a cross-sectional study conducted twelve weeks after delivery. At that time, 48 women (mean age: 25.9 years) with PPD and 50 healthy controls (mean age: 25.2 years) completed questionnaires on depressive symptoms. Further, at the same time point, 6 cm lengths of hair strands were taken, providing samples of hair steroids 12 weeks before and 12 weeks after delivery in order to analyze hair steroids (cortisol, cortisone, progesterone, testosterone, and dehydroepiandrosterone (DHEA)). Results: Compared to those of women without PPD, hair steroid levels (cortisol, cortisone, progesterone) were significantly lower in women with PPD both before and after delivery. Lower prenatal cortisone and progesterone levels predicted higher depression scores 12 weeks after delivery. Lower prenatal levels of cortisol and progesterone and higher levels of DHEA, and postnatal lower levels of cortisol, cortisone, and progesterone, along with higher levels of DHEA predicted PPD-status with an accuracy of 98%. Conclusions: PPD is associated with blunted hair cortisol, cortisone, and progesterone secretions both pre- and postpartum. Such blunted steroid levels appear to reflect a stress responsivity that is less adaptive to acute and transient stressors. It follows that prenatally assessed low hair cortisol and progesterone levels, along with high DHEA levels, are reliable biomarkers of post-partum depression 12 weeks after delivery.
Highlights
It is estimated that a few days after delivery 40%–80% of mothers suffer from symptoms of depression (“baby blues”)
We explored the question of whether levels of other steroids either change from the pre- to postnatal stage or whether levels of other steroids differ between participants with and without post-partum depression (PPD)
Samples were washed in 2.5 mL isopropanol for 3 min, and steroid hormones were extracted from 7.5 mg of whole, non-pulverized hair using 1.8 mL methanol in the presence of 50 μL cortisol-d4, cortisone-d7, testosterone-d5, DHEA-d4, and progesterone-d9 as internal standards for 18 h at room temperature
Summary
It is estimated that a few days after delivery 40%–80% of mothers suffer from symptoms of depression (“baby blues”). From a psychiatric point of view, PPD is regarded as a major depressive disorder, with the specifier of onset four weeks after delivery [4], and, as such, must be treated following evidence-based algorithms To further support such algorithms, research on psychophysiological variables has been undertaken to explain the emergence and maintenance of PPD [10,11,12]. We focused on steroids (cortisol, cortisone, progesterone, testosterone and dehydroepiandrosterone or DHEA), and we examined the relation of levels of these steroids with symptoms of depression (both antepartum and postpartum) To this end, we analyzed steroids in hair strands, as hair strands are considered a retrospective calendar and provide insight into changes in steroid secretion over time and as a function of women’s long-term affective states. Above all, cortisol, were mainly assessed in blood, saliva, and urine, and, to a much lesser extent, in hair
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