Abstract
The early postpartum period is associated with increased risk for affective and psychotic disorders. Because maternal dopaminergic reward system function is altered with perinatal status, dopaminergic system dysregulation may be an important mechanism of postpartum psychiatric disorders. Subjects included were non-postpartum healthy (n=13), postpartum healthy (n=13), non-postpartum unipolar depressed (n=10), non-postpartum bipolar depressed (n=7), postpartum unipolar (n=13), and postpartum bipolar depressed (n=7) women. Subjects underwent 60 min of [11C]raclopride–positron emission tomography imaging to determine the nondisplaceable striatal D2/3 receptor binding potential (BPND). Postpartum status and unipolar depression were associated with lower striatal D2/3 receptor BPND in the whole striatum (p=0.05 and p=0.02, respectively) that reached a maximum of 7–8% in anteroventral striatum for postpartum status (p=0.02). Unipolar depression showed a nonsignificant trend toward being associated with 5% lower BPND in dorsal striatum (p=0.06). D2/3 receptor BPND did not differ significantly between unipolar depressed and healthy postpartum women or between bipolar and healthy subjects; however, D2/3 receptor BPND was higher in dorsal striatal regions in bipolar relative to unipolar depressives (p=0.02). In conclusion, lower striatal D2/3 receptor BPND in postpartum and unipolar depressed women, primarily in ventral striatum, and higher dorsal striatal D2/3 receptor BPND in bipolar relative to unipolar depressives reveal a potential role for the dopamine (DA) system in the physiology of these states. Further studies delineating the mechanisms underlying these differences in D2/3 receptor BPND, including study of DA system responsivity to rewarding stimuli, and increasing power to assess unipolar vs bipolar-related differences, are needed to better understand the affective role of the DA system in postpartum and depressed women.
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Acknowledgements
We thank members of the PET Facility Staff who carried out the acquisition of PET data and care of all subjects during PET procedures; Tova Saul, Andrea Confer, Michael Lightfoot, Carl Becker, Danielle Mullen, Julie Giombetti, and Alicia Corominal who assisted with study recruitment, data entry, image analysis, and endocrine analyses; NIMH, NARSAD for supporting this research; Magee-Women's Clinical Research Center and Womens Behavioral HealthCARE for providing infrastructure to run this project; and Medela for donating a breast pump for use during scanning procedures. The study was financially supported by National Alliance for Research in Schizophrenia and Depression; MH64561 to ELMK; M01-RR000056 to University of Pittsburgh; CCM's time was supported by K24 MH64625; and KLW's time was supported by MH 57102 and MH 53735. Data for non-postpartum control subjects were obtained with R01 MH042984.
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Eydie L Moses-Kolko: Small honorarium given as guest speaker for La Leche League Regional Conference Summer, 2009.
Julie Price: No financial interests to disclose.
Katherine L Wisner: Katherine L. Wisner received transdermal estradiol patches and matching placebo patches for an NIMH-funded randomized controlled trial, and participated in an advisory board for Eli Lilly Company.
Carolyn C Meltzer: No financial interests to disclose.
Sarah Berga: Board of Directors: Member, University of Virginia Medical Alumni Association Board of Directors, 2007 to present (Gratis). CONSULTANTSHIP: Agile Therapeutics Medical Advisory Board, March 2011; AHC Media; LLC, Consultant, Annual business meeting, April 2008, April 2009, June 2010; Noven Pharmaceutical Medical Advisory Board, Feb 2010; Promedica Communications, Bayer Pharmaceutical Medical Advisory Board Meeting, June 2009, August 2009; Watson Pharmaceutical Women's Health Strategic Advisory Board, April 2010. LEGAL CONSULTING: Kirkland and Ellis, LLC; Leydig, Voit and Mayer, LLC; Reed Smith, LLC. Editorial Boards and Positions: ACOG, Editorial Committee, Guidelines for Women's Health Care, 2009–2011(Gratis); American Journal of Obstetrics and Gynecology, 2003 to present (Gratis); Advisory Board for Subspecialty Neuroendocrinology and Reproductive Neurobiology; The Endocrine Society: Member, Endocrine Self-Assessment Program Committee (June 2007–June 2011); Clinical Practice Guideline Task Force on Hypothalamic Amenorrhea, January 2011 to present (Gratis);Editorial Board for Endocrinology, January 2010 to present (Gratis); Menopause, Editorial Board, 1999 to present (Gratis). NIH Study Section reviewer: Society for Women's Health Research, ISIS CVD Network Member, 2009 to present. UpToDate Peer Review Board for 2005 to present.
Anthony A Grace: Consultant for Johnson & Johnson; research grants from Lundbeck, GSK, EMD Serono, pharmaceutical company talks (Abbott, Roche, Lilly); advisory boards (as non-member invited speaker, including Merck).
Barbara H Hanusa: No financial interests to disclose.
Teresa Lanza di Scalea: No financial interests to disclose.
Walter H Kaye: No financial interests to disclose.
Carl Becker: No financial interests to disclose.
Wayne C Drevets: Has served as a consultant to Pfizer, Johnson and Johnson, Eisai, and Rules Based Medicine.
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Moses-Kolko, E., Price, J., Wisner, K. et al. Postpartum and Depression Status are Associated With Lower [11C]raclopride BPND in Reproductive-Age Women. Neuropsychopharmacol 37, 1422–1432 (2012). https://doi.org/10.1038/npp.2011.328
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