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HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression

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Abstract

It is unclear whether women with a history of postpartum depression (PPD) have residual, abnormal hypothalamic-pituitary-adrenal (HPA) axis reactivity, as has been reported in major depression (MDD). Further unclear is whether the abnormalities in HPA axis reactivity associated with MDD represent a stable, underlying predisposition or a state-dependent phenomenon. This study sought the following: (1) to determine if euthymic postpartum women with a history of depression have an abnormal HPA axis reactivity to pharmacologic and psychological challenges and (2) to compare HPA reactivity in women with histories of PPD versus MDD. As a secondary objective, we wanted to determine the influence of trauma history on HPA axis function. Forty-five parous (12–24 months postpartum), euthymic women with history of MDD (n = 15), PPD (n = 15), and controls (n = 15) completed pharmacologic (dexamethasone/corticotropin-releasing hormone (CRH) test [DEX/CRH]) and psychological (Trier social stress test [TSST]) challenges during the luteal phase. Outcome measures were cortisol and adrenocorticotropic hormone (ACTH) response after DEX/CRH, and blood pressure, heart rate, epinephrine, norepinephrine, and cortisol response during the TSST. All groups had robust cortisol and ACTH response to DEX/CRH and cortisol response to TSST. Groups did not differ significantly in cortisol or ACTH response to DEX/CRH or in blood pressure, heart rate, epinephrine, norepinephrine, or cortisol response to TSST. Cortisol/ACTH ratio did not differ significantly between groups. Trauma history was associated with decreased cortisol response to DEX/CRH in women with histories of MDD, which was not significant after correction (F 8,125, p = 0.02, Greenhouse-Geisser corrected p = 0.11). Currently euthymic women with histories of MDD or PPD did not demonstrate residual abnormal stress responsivity following administration of either a pharmacologic or psychological stressor.

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Acknowledgements

We would like to thank the study participants who generously gave of their time. We would also like to acknowledge the late Dr. Robert M. Hamer, biostatistician, for his contribution to the study design, his thoughtful guidance, and the invaluable role he played in the training of Dr. Ferguson and so many others at The University of North Carolina at Chapel Hill.

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Authors and Affiliations

  1. Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA

    Elizabeth H. Ferguson, Arianna Di Florio, Brenda Pearson, Karen T. Putnam, Susan Girdler, David R. Rubinow & Samantha Meltzer-Brody

  2. Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK

    Arianna Di Florio

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  1. Elizabeth H. Ferguson
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  2. Arianna Di Florio
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  3. Brenda Pearson
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  4. Karen T. Putnam
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  5. Susan Girdler
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  6. David R. Rubinow
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  7. Samantha Meltzer-Brody
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Correspondence to Elizabeth H. Ferguson.

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Funding

This research was supported by the National Institutes of Health Grant K23MH085165 (PI: Meltzer-Brody).

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ferguson, E.H., Di Florio, A., Pearson, B. et al. HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression. Arch Womens Ment Health 20, 411–420 (2017). https://doi.org/10.1007/s00737-017-0716-y

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  • DOI: https://doi.org/10.1007/s00737-017-0716-y

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