Kammerer M, Taylor A, Glover V
Institute of Reproductive and Developmental Biology, Fetal and Neonatal Stress Research Centre, Imperial College, London, UK.
Arch Womens Ment Health. 2006 Jul;9(4):187-96. doi: 10.1007/s00737-006-0131-2. Epub 2006 May 19.
Episodes of depression and anxiety are as common during pregnancy as postpartum. Some start in pregnancy and resolve postpartum, others are triggered by parturition and some are maintained throughout. In order to determine any biological basis it is important to delineate these different subtypes. During pregnancy, as well as the rise in plasma oestrogen and progesterone there is a very large increase in plasma corticotropin releasing hormone (CRH), and an increase in cortisol. The latter reaches levels found in Cushing's syndrome and major melancholic depression. Levels of all these hormones drop rapidly on parturition.We here suggest that the symptoms of antenatal and postnatal depression may be different, and linked in part with differences in the function of the hypothalamic pituitary adrenal (HPA) axis. There are two subtypes of major depression, melancholic and atypical, with some differences in symptom profile, and these subtypes are associated with opposite changes in the HPA axis. Antenatal depression may be more melancholic and associated with the raised cortisol of pregnancy, whereas postnatal depression may be more atypical, triggered by cortisol withdrawal and associated with reduced cortisol levels. There is evidence that after delivery some women experience mild bipolar II depression, and others experience post traumatic stress disorder. Both of these are associated with atypical depression. It may also be that some women are genetically predisposed to depression of the melancholic type and some to depression of the atypical type. These women may be more or less vulnerable to depression at the different stages of the perinatal period.
孕期抑郁和焦虑发作与产后一样常见。有些在孕期开始，产后缓解；有些由分娩引发；还有些在整个孕期持续存在。为了确定其生物学基础，区分这些不同亚型很重要。孕期，除了血浆雌激素和孕酮水平升高外，血浆促肾上腺皮质激素释放激素（CRH）大幅增加，皮质醇水平也升高。后者达到库欣综合征和重度忧郁症抑郁症时的水平。这些激素水平在分娩时迅速下降。我们在此提出，产前和产后抑郁症的症状可能不同，部分与下丘脑 - 垂体 - 肾上腺（HPA）轴功能差异有关。重度抑郁症有两种亚型，忧郁型和非典型型，症状表现有所不同，且这些亚型与HPA轴的相反变化相关。产前抑郁症可能更倾向于忧郁型，与孕期皮质醇升高有关，而产后抑郁症可能更倾向于非典型型，由皮质醇撤退引发且与皮质醇水平降低有关。有证据表明，分娩后一些女性会经历轻度双相II型抑郁症，另一些会经历创伤后应激障碍。这两种情况都与非典型抑郁症有关。也可能有些女性在基因上易患忧郁型抑郁症，有些易患非典型型抑郁症。这些女性在围产期的不同阶段可能或多或少更容易患抑郁症。
