Color & Control:

Why brain imaging is crucial to understanding postpartum depression

We have long known that 75% of pregnant women develop ‘baby blues’ and 20% develop postpartum depression, but we have failed to investigate why. Pregnancy is a profound experience that often triggers anxiety and depression in women. Now, for the first time, we are conducting brain scans to study how brain activity changes during pregnancy. These scans will finally begin to enable us to understand how women’s brains change throughout pregnancy, offering insightsinto how maternal mental illness develops.

What current mental health research overlooks about postpartum depression
Pregnant women share an extremely high risk of developing mental illness. In the US,20% develop a mood or anxiety disorder during pregnancy or shortly after. Severe mental illness during or after pregnancy has the potential to endanger both mothers and their children. 

Until recently, people attempted to explain postpartum depression away as normal or routine. Now, we are collectively acknowledging that symptoms of depression can be traced to real chemical and physical changes in our brains. As a society, facing the stigma of mental health head-on is a leap forward, but it is not an end in itself. We have provided an avenue for mothers to express their pain, but we have not given them the answers they need. 

Confronting stigma is not an end—it’s a beginning. If we accept that depression is brought on by changes in our brains, we need to go one step further and learn about those changes. Psychologists and psychiatrists have studied mental illness and its connection to the body, but without looking at the disorder medically and biologically, we will never uncover a cause or a cure.

The importance of brain imaging in understanding changes in function during pregnancy
Our scientific understanding of the changes that occur in women’s brains during pregnancy is limited. Neuroimaging is our primary means of learning about human brain function, but historically, we have excluded pregnant women from these studies.

The scientific community has been hesitant to study pregnant women with magnetic resonance imaging (MRI) technology because the safety profile was unclear. Today, we have mounting evidence that proves MRIs are safe for both pregnant mothers and their unborn babies. As we pair brain scans with biological and emotional tests and surveys, we will be able to shed light on why and how postpartum depression develops. 

We will be among the first to use MRI scans to understand how pregnant women’s brains change. We will track hormone levels, record brain circuitry, and ask women to report the emotions they experience before, during, and after pregnancy.

Our research undertakes two major goals. First, we seek to understand how profound events alter the human brain. Postpartum depression is the only type of mental illness occurring during a predictable window, making it a significant means of studying the effects of many types of depression.

Second, we hope to develop ways of better identifying women at risk of mental illness during pregnancy. Studying the brain during this critical time has the potential to impact how we predict and treat this form of mental illness.

Determining causation is a vital part of treatment and prevention
To date, the scientific community can offer no single cause for postpartum depression. Doctors attribute this form of mental illness to a variety of physical, hormonal, social, psychological, and emotional factors. A few suggested causes include hormonal fluctuations, financial stress, emotional stress, sleep deprivation, marital strife, inadequate support systems, a personal history of depression, a family history of mental illness, and depression during a previous pregnancy. 

Without being able to pinpoint a definite cause, psychologists treat postpartum depression in the same way they treat general depression. Common treatments include psychotherapy, supportive counseling, increased social support from friends and family, greater emotional support from partners, antidepressants, relaxation or massage, hormone therapy, and bright light therapy.

MRI scans will enable us to learn how each woman’s individual brain changes during pregnancy. Our goal is to understand exactly why and how these changes occur. As we study brain scans of women with this condition, we will learn much more about its cause. In time and with more innovative research, we will determine if the factors triggering depression vary from one woman to another. We can then offer targeted treatments to women dealing with postpartum depression that improve the lives of these new mothers, their babies, and their families.

Dr. Jonathan Power is an Assistant Professor of Psychiatry at Weill Cornell Medicine & Research Fellow at the 1907 Foundation.

What mums need to know…

Q. Every woman is different, but are there some common signs and symptoms?

A. Yes, depressed mood or depression with anxiety. Anhedonia, which involves loss of interest in things that would normally bring pleasure (including the baby). Changes in weight or appetite. Sleep disturbances and fatigue along with physical feelings of restlessness, jumpiness and edginess. Excessive feelings of guilt or worthlessness. For some, there even frequent thoughts of death or suicide.

Q. What are the causes and risk factors?

A. Physical, hormonal, social and psychological factors may all play a role as triggers. Risk factors include a personal or family history of depression and a previous experience of postpartum depression.

Q. How is PPD diagnosed and treated?

A. Firstly, mums are reluctant to ask for help but when left untreated, depression can be detrimental to mum’s health and disruptive to both family relations and mother-infant attachments. Treatment options include: psychotherapy and cognitive behaviour therapy as well as supportive counseling hormone or light therapy and antidepressants. Of note: mothers are sometimes advised to wait 8 or 9 hours after taking antidepressants before breastfeeding.

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