New Brain Study Reveals Current Understandings of Postpartum Depression May Be Wrong

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Postpartum depression which effects up to 20% of all new mothers, is the single greatest complication associated with childbirth. A newly published brain study led by Dr. Michael E. Silverman, a leading expert in postpartum depression from the Mount Sinai School of Medicine in New York, sheds light on the neural dysfunction associated with postpartum depression and why some new mothers may unintentionally place their newborns in harms way.

Functional magnetic resonance image of brain activity in women who recently gave birth.

Dr. Michael E Silverman led the first functional magnetic resonance imaging study of postpartum depression in 2007. Results published this week from a new study provide further insight into the understandings of depression in the first few weeks following childbirth.

The improper treatment of a bipolar type postpartum depression can have catastrophic consequences for both the mother and child.

A new study published this week provides evidence that the way doctors currently think of postpartum depression may be incorrect. The research was published this week in the scholarly journal, Archives of Women's Mental Health - a premiere, peer reviewed, scientific journal dedicated to understanding mood and anxiety disorders specific to women.

Clinicians and scientists at the Mount Sinai School of Medicine in New York City used state of the art brain imaging technology to understand how the brains of women with postpartum depression differed from non-depressed postpartum woman. The results of the study were unexpected.

"Depression comes in two flavors, unipolar and bipolar." says Dr. Michael E. Silverman lead author of the study. "Unipolar depression is characterized by severe depression, whereas bipolar type depressions include times of unusually elevated mood or energy – referred to as mania or hypomania." According to the DSM-IV, the diagnostic manual used by psychiatrist and psychologists, postpartum depression is classified as a unipolar type depression. The results of the study suggest this classification might be inaccurate.

According to Dr. Silverman, "Certain areas of the brain, particularly a cortical region known as the amygdala, are known to become very active in unipolar depression. The brains of the depressed postpartum woman however looked much different. In fact, the more severe the postpartum depression the less the women’s brains responded how one would expect in a unipolar depression."

Despite the current classification of postpartum depression, doctors and clinicians with experience treating depressed mothers often note specific differences between unipolar depression and the depression that occurs immediately after childbirth. The study published this week provides new brain evidence suggesting that postpartum depression might be neurologically different as well.

Postpartum depression, the most common complication associated with childbirth, affects approximately 20% of all new mothers or nearly 800,000 US women annually. If left untreated the depression can last for months or even years. While depression after childbirth has been reported by doctors since the time of Hippocrates (400 BC), the causes of postpartum depression remain poorly understood.

"Compounding the problem is the fact that new mothers are often expected to be superwomen, managing personal, home and often work lives in addition to caring for a new child, all on about 75% less sleep", says Silverman. "And while symptoms of hypomania should be considered diagnostically significant, especially in the postpartum period, at the current time they aren't." Silverman further warns, "The improper treatment of a bipolar type postpartum depression can have catastrophic consequences for both the mother and child." Indeed, research has suggested that postpartum depression is the single greatest cause of maternal death.

Silverman notes an additional importance of this finding, “The period immediately following birth is a critical time for the newborn’s development and postpartum depression can constitute a serious threat to the infant’s well-being. While these results are surprising, they help to explain why mothers who suffer from postpartum depression are prone to making decisions that put their infant(s) at increased risk for harm.”

About the lead scientist:
Dr. Michael E. Silverman is a psychologist and neuroscientist at the Mount Sinai School of Medicine in New York City. Earlier this month he co-authored the largest US population based study of severe postpartum depression (2.4 million woman), published in the scholarly journal Annals of Epidemiology.

Available for commentary and discussion:
Dr. Silverman regularly appears on national television networks including CNN, CW Network, Fox News, HLN and Tru-TV's, In Session. His research has been reported in various lay outlets including: Cosmopolitan Magazine; Brain, Child Magazine; Esperanza (Depression and Anxiety) Magazine; First for Women Magazine; Fit Parent; Fit Pregnancy; The New Yorker; The New York Daily News; The Hartford Courant; The Wall Street Journal; and WebMD. He can be reached at 212-659-8813 or michael.siverman(at)mssm(dot)edu


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