Relationship of monoamine oxidase-A distribution volume to postpartum depression and postpartum crying

Abstract

Postpartum depression (PPD) has a prevalence rate of 13% and a similarly high proportion of women report a subclinical state of one or more major depressive episode symptoms. The aim was to investigate whether monoamine oxidase-A (MAO-A) VT, an index of MAO-A density, is increased in the prefrontal and anterior cingulate cortex (PFC and ACC), during PPD or when a PPD spectrum symptom, greater predisposition to crying, is present. MAO-A is an enzyme that increases in density after estrogen decline, and has several functions including creating oxidative stress, influencing apoptosis and monoamine metabolism. Fifty-seven women were recruited including 15 first-onset, antidepressant naive, PPD subjects, 12 postpartum healthy who cry due to sad mood, 15 asymptomatic postpartum healthy women, and 15 healthy women not recently pregnant. Each underwent [(11)C]-harmine positron emission tomography scanning to measure MAO-A VT. Both PPD and greater predisposition to crying were associated with greater MAO-A VT in the PFC and ACC (multivariate analysis of variance (MANOVA), group effect, F21,135=1.856; p=0.019; mean combined region elevation 21% and 14% in PPD and crying groups, respectively, relative to postpartum asymptomatic). Greater MAO-A VT in the PFC and ACC represents a new biomarker in PPD, and the PPD symptom of predisposition to crying. Novel strategies for preventing PPD (and some PPD symptoms) may be possible by avoiding environmental conditions that elevate MAO-A level and enhancing conditions that normalize MAO-A level. These findings also argue for clinical trials in PPD with the newer, well-tolerated MAO-A inhibitor antidepressants.

Figure 1

Greater monoamine oxidase-A V_T level in postpartum depression compared with healthy controls. MAO-A V_T was significantly elevated in the postpartum depression (PPD) group and the postpartum group with crying due to sad mood (multivariate analysis of variance, effect of group, F_6,104=3.265, p=0.006) and significant univariate effects found in the prefrontal and anterior cingulate cortex (PFC and ACC), thalamus, dorsal putamen, and midbrain (p=0.000–0.035). Post-hoc testing in PFC and ACC showed significant elevation in MAO-A V_T in PPD group relative to both healthy groups (p⩽0.05, Least Significant Difference (LSD) test). Postpartum subjects who were crying due to sad mood showed a significant elevation in MAO-A V_T relative to both healthy groups in the PFC, and relative to the healthy recently pregnant group in the ACC (p⩽0.05, LSD test).