news item: “study finds genetic prediction of postpartum depression”

I don’t discuss it much, but I went through a Very Bad Time after my first son was born. When he was about 4 months old, my husband realized that I was no longer doing things like leaving the house, showering, eating, sleeping, etc. He took me to the emergency room. A psychiatrist, social worker, mental health nurse doing home visits, support groups, and months of medication later and I was semi-human again.

Postpartum depression is FOR REAL. It is not the “baby blues” nor is it “regular” depression, something I have struggled with as well. Without going into much detail (as this is something I still struggle greatly with sharing) I was not myself. And on top of it all, I was debilitated with guilt and shame. How could I feel this way when I just won the lottery?

In hindsight, I had many risk factors for PPD all lined up neatly in a row. A history of anxiety and depression, suffering back to back miscarriages, infertility, an extremely stressful pregnancy, traumatic birth experience, lack of support after birth, and so on. However something I had never considered was whether I was genetically predisposed to it. Yesterday on Twitter I came across an article (thanks KeAnne, you re-tweeter you) that has me thinking…

Study Finds Genetic Prediction of Postpartum Depression

It is not clear what causes postpartum depression, a condition marked by persistent feelings of sadness, hopelessness, exhaustion and anxiety that begins within four weeks of childbirth and can last weeks, several months or up to a year. An estimated 10 to 18 percent of all new mothers develop the condition, and the rate rises to 30 to 35 percent among women with previously diagnosed mood disorders.

The researchers later confirmed their findings in humans by looking for epigenetic changes to thousands of genes in blood samples from 52 pregnant women with mood disorders. The women were followed both during and after pregnancy to see who developed postpartum depression.

The researchers noticed that women who developed postpartum depression exhibited stronger epigenetic changes in those genes that are most responsive to estrogen, suggesting that these women are more sensitive to the hormone’s effects. Specifically, two genes were most highly correlated with the development of postpartum depression. TTC9B and HP1BP3 predicted with 85 percent certainty which women became ill.

“We were pretty surprised by how well the genes were correlated with postpartum depression,” Kaminsky says. “With more research, this could prove to be a powerful tool.”

Without going off on a tangent about study size, sample population, and commentary on methodology, I will say that this study is very interesting. It is general assumed (even by mental health professionals) that PPD can be attributed to “wacky hormones being all out of whack.”  More specifically, that a drop in estrogen levels affects mood significantly in some women, but not others. Although, that reason doesn’t answer the question of why this woman and not that one?

This study suggests that certain woman are more sensitive to changes in estrogen. What is interesting about this research is that it could potentially lead to a blood test performed in the third trimester to determine whether these changes are taking place and raise a potential red flag for the woman, her family, and her healthcare provider.  The lead researcher, Zachary Kaminsky, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins, hopes that this could help HCPs and mothers make informed decisions about treatment for depression during and after pregnancy, including the appropriate use of medication when weighed against other risks. In other words, if you knew you higher risk, you could better prepare for the possibility that it might be more likely to happen.

I have been chewing on this all morning, and will likely continue to for a while. I felt that I had no choice but to go on medication or risk not being able to parent my child. Curiously, I have not remotely had the same experience after the birth of my second son, despite life (and life events) being more stressful now. I attribute this to a a different pregnancy, and empowering birth, and experience as a mother, but also to being on the lookout for The Very Bad Time – Part 2. I have written here before that I lied to my HCP about feeling depressed during pregnancy. So as I read this over and over this morning, I can’t help thinking that normalizing mental health issues before and after pregnancy is a good thing. Yes, a blood test like this raises moral and ethical questions and could be used for all sorts of nefarious purposes. But what if it is used for good?

I’m chewing on it.

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If you or someone you know is struggling with postpartum depression, an excellent resource is Postpartum Progress. Click on GET HELP for more information.

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What do you make of this research? Can you see this being added to the battery of available pregnancy testing?

If this test were available, would you choose to take it? Why or why not?

Prior to giving birth did you discuss mental health issues (relating to pregnancy and the postpartum period) with your healthcare provider? 

Did you have adequate emotional support (or access to resources) after bringing your child home? 

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SRBSarah is a former high school teacher, turned medical writer, turned SAHM to two boys. She enjoys beer, knitting, gardening, and cheese, and is striving to raise boys who can will do their own laundry and cooking. This urban mama parents with an ever-evolving mix of natural, attachment and RIE principles with a dash of by-the-seat-of-her-pants for good measure. She blogs about her life at a sausage party at Little Chicken Nuggets.

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Comments

  1. I read about this via Postpartum Progress’s tweet. I found it so fascinating and exciting that I re-read the blog post five times. It backed up some of my own theories on PP mood disorders (and mood disorders in general).

    I could write a novel based on the questions you wrote above 🙂 But I’ll say this: PP mood disorders need to be discussed prior to birth and not be a five second conversation at discharge time as it was with me. My OB dismissed my feelings of anxiety during G’s pregnancy as normal because of my miscarriage when I think they should have been discussed. If there were a test available to me, I’d take it because I know I’m at higher risk. I wish there was one available before G’s birth just so I could have raised more awareness about PPD with my husband (he was a non-believer until I was diagnosed after G’s birth, wouldn’t really discuss it with me until the 5 sec convo at discharge).

    What drives me most nuts about my PPD experience is that I had help and resources. I did have people watching out for me, BUT no one who knew me best suggested I see a doctor when they saw I wasn’t myself. I found out after I was on zoloft that these people “figured” I had PPD. Hubby felt lost; he really didn’t know how to help me. If I had tested positive as a PPD risk patient, I’d like to think that someone would have MADE me get help a little sooner because we probably would have told people what my results were.

    So I’m a supporter of another blood test. I’m bummed that one might not be available before I’m done family building, as going down the PPD rabbit hole is something that Hubby and I are terrified of. It would be helpful to know if it’s something we shold be prepared better for (though, 85% still leaves a large room for error, so IMO you need to be prepared either way). But if this is something that can help future mothers and fathers and families bring this issue out into the open to discuss with their providers then I’m all for it.

    Sorry if I rambled. I have So Many Things to say about this whole subject 🙂

  2. Good for you for talking so openly about this!

    As for your questions – my answers are YES to all 4.

    I certainly hope that once this is proven further, that the testing will be added to regular OB testing. Too many people are afraid to answer “yes” to questions about feeling depressed. I understand why that is – but if this test was just part of the regular testing, it would probably make it SO MUCH easier for women to answer “yes” because they would know they should be looking out for it – and that it’s out of their control.

    I would absolutely choose to take the test if it was available. We have lots of cancer in our family, so those who have had it have had genetic testing done to see if we have the genetic strains of cancer or not (we don’t – which surprises me). I view this to be the exact same thing. Wouldn’t I want to know if I was predisposed to breast cancer? YES. Wouldn’t I want to know if I was predisposed to PPD? YES. PPD can be so harmful to mothers and their babies, that it just makes sense to me to test for it. To each his own, but I’d definitely take the test even if it wasn’t covered by insurance. I say that because I’ve had my own issues with depression/anxiety for years (which went away after Matthew was born), and I worried constantly that I would have PPD because of that. I would want to know if it was likely for me!

    OMG YES, I totally talked to Dr. H about my worries about having PPD prior to giving birth. I was certain I’d have it since my mother had it very severely, and because of my own struggles prior to having my son. I thought for sure I’d have it, and I wanted Dr. H to know that so that he could respond quickly if/when I would call for help. I went further and discussed my concerns with my husband too, and had Dr. H explain to him what to watch for to help me determine if I did have PPD or not. We three really worked as a team to fully understand the condition and the signs of the condition so that we’d be prepared post-birth.

    I feel like I had adequate support. B watched me like a hawk, and asked me how I was feeling all the time. When we ran into some serious breastfeeding issues, he really kept tabs on me. He had 4 weeks of paternity leave and took an extra week to stay with me, so I felt supported 24/7 the entire time. By the time he went back to work, we knew I was fine (and we knew that very early, actually, because we kept checking in with one another). Our son’s pediatrician asked me all the time if I was OK, and also asked B. Our lactation consultant asked us as well. I feel like I had TONS of support.

    Great news item!

  3. Very, very interesting. I can see pros and cons to being tested for this: what if the anxiety about getting it (if the test was positive) becomes overwhelming? But it would also give someone a chance (as well as their partner/family members) to prepare for the worst-case scenario…I’ll be thinking about this for a while.

    I’m sorry you went through PPD. It’s truly horrible. Thanks for sharing your experience.

  4. Yes I’d have the test. I was told after my ob referred me for assessment during pregnancy I had a 50/50 chance of PND because of my history with depression and bedrest in pregnancy..

    Then my nephew committed suicide when jman was 9 weeks old…and I thought here we go. I’m stuffed.

    I find being a mum hard, i thought i was getting anxiety issues, but they settled and so far no pnd. Still, I would definitely have the test. The support is a little see through at times (quizzes at the community nurse are so lame) and it is too easy to lie through. I briefed my husband on what to look for and when to step in & take charge, ensured I was on someone’s books who knew my history before I gave birth, and had lactation people lined up too. In the end I didn’t need it, and my husband stopping on bad days, holding me by the shoulders and saying “you’re doing an amazing job” was enough to scare the ghosts of depressions past away. The link to estrogen totally totally makes sense.

  5. I’m so glad that you shared this and that you reviewed this paper so succinctly. I know it will help a lot of women.

Trackbacks

  1. […] examined (and “chewed on”) a recent study on a possible genetic component to post-partum depression. There’s a lot to think about here, and this take on susceptibility to mental health […]

  2. […] emotions were extreme. I was no longer able to function. My husband took me to the emergency room. I recently wrote an article for PAIL discussing a study related to genetic markers for PPD. While I was writing, I went searching for a […]

  3. […] emotions were extreme. I was no longer able to function. My husband took me to the emergency room. I recently wrote an article for PAIL discussing a study related to genetic markers for PPD. While I was writing, I went searching for a […]

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