The dynamic serotonin system of the maternal brain

Abstract

Many pregnant and postpartum women worldwide suffer from high anxiety and/or depression, which can have detrimental effects on maternal and infant well-being. The first-line pharmacotherapies for prepartum and postpartum affective disorders continue to be the selective serotonin reuptake inhibitors (SSRIs), despite the lack of large well-controlled studies demonstrating their efficacy in reproducing women and the potential for fetal/neonatal exposure to the drugs. Prepartum or postpartum use of SSRIs or other drugs that modulate the brain’s serotonin system is also troubling because very little is known about the typical, let alone the atypical, changes that occur in the female central serotonin system across reproduction. We do know from a handful of studies of women and female laboratory rodents that numerous aspects of the central serotonin system are naturally dynamic across reproduction and are also affected by pregnancy stress (a major predisposing factor for maternal psychopathology). Thus, it should not be assumed that the maternal central serotonin system being targeted by SSRIs is identical to non-parous females or males. More information about the normative and stress-derailed changes in the maternal central serotonin system is essential for understanding how serotonin is involved in the etiology of, and the best use of SSRIs for potentially treating, affective disorders in the pregnant and postpartum populations.

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Acknowledgements

The author would like to thank M. Allie Holschbach, Erika M. Vitale, Carl D. Smith, and Katie M. Harding for conducting the research from the author’s lab that was discussed in this review.

Funding

Some of the author’s research described herein was supported in part by NIH grants R01HD057962, NRSA F32MH099892, and NRSA F32MH83344.

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Correspondence to Joseph S. Lonstein.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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This article is part of the Topical Collection on Neurobiology of Maternal Mental Illness

Guest Editor: Jodi Pawluski

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Lonstein, J.S. The dynamic serotonin system of the maternal brain. Arch Womens Ment Health 22, 237–243 (2019). https://doi.org/10.1007/s00737-018-0887-1

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Keywords

  • Dorsal raphe
  • Neuroplasticity
  • Postpartum anxiety
  • Postpartum depression
  • Serotonin
  • SSRI