The role of reproductive hormones in postpartum depression.
The role of reproductive hormones in postpartum depression.
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DOI：
10.1017/s1092852914000480
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发表时间：
2015-02
期刊：
影响因子：
3.3
通讯作者：
Rubinow DR
中科院分区：
文献类型：
--
作者：
Schiller CE;Meltzer-Brody S;Rubinow DR
尽管几十年来的研究旨在确定产后抑郁症（PPD）的原因，但PPD仍然很常见，其原因知之甚少。许多人认为产后抑郁症的发病与围产期生殖激素的快速变化有关。尽管许多人类和非人类动物研究支持生殖激素在PPD中的作用，但一些研究未能发现激素浓度与PPD之间的关联。本综述的目的是检验怀孕和产后期间生殖激素水平的波动是否会引发易感妇女PPD的假设。我们讨论并整合了关于PPD动物模型的文献以及生殖激素和PPD的人类研究。我们还讨论了PPD的其他生物学模型，以证明多种PPD表型的潜力，并描述了可能导致情感性功能障碍的生殖激素变化和甲状腺功能、免疫功能、HPA轴功能、乳原激素和遗传表达的改变之间的复杂相互作用。生殖激素在产后抑郁症中的作用主要有三个方面的研究：非人类动物研究，产后激素水平和情绪症状的相关性研究，以及激素操纵研究。生殖激素几乎影响到与产后抑郁症有关的每一个生物系统，有一部分妇女似乎对围产期激素水平变化的影响特别敏感。我们认为这些女性构成了“激素敏感”的PPD表型，应该独立于其他PPD表型进行研究，以确定潜在的病理生理和开发新的治疗靶点。
Despite decades of research aimed at identifying the causes of postpartum depression (PPD), PPD remains common, and the causes are poorly understood. Many have attributed the onset of PPD to the rapid perinatal change in reproductive hormones. Although a number of human and non-human animal studies support the role of reproductive hormones in PPD, several studies have failed to detect an association between hormone concentrations and PPD. The purpose of this review is to examine the hypothesis that fluctuations in reproductive hormone levels during pregnancy and the postpartum period trigger PPD in susceptible women. We discuss and integrate the literature on animal models of PPD and human studies of reproductive hormones and PPD. We also discuss alternative biological models of PPD to demonstrate the potential for multiple PPD phenotypes and to describe the complex interplay of changing reproductive hormones and alterations in thyroid function, immune function, HPA axis function, lactogenic hormones, and genetic expression that may contribute to affective dysfunction. There are three primary lines of inquiry that have addressed the role of reproductive hormones in PPD: non-human animal studies, correlational studies of postpartum hormone levels and mood symptoms, and hormone manipulation studies. Reproductive hormones influence virtually every biological system implicated in PPD, and a subgroup of women seem to be particularly sensitive to the effects of perinatal changes in hormone levels. We propose that these women constitute a “hormone-sensitive” PPD phenotype, which should be studied independent of other PPD phenotypes to identify underlying pathophysiology and develop novel treatment targets.