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Depression during pregnancy and postpartum: An Integrative and Precision Medicine-based Approach

An Overview of Depression during the Perinatal Period

Depressive episodes during the pregnancy and post-partum period are common, affecting 10 to 20% of women. Postpartum depression (PPD) in particular, impacts 15% of women. In addition, depression during the perinatal period is often under-recognized by healthcare professionals and many women struggle without support or treatment. So what are some holistic and personalized approaches to prevent and treat depression experienced by women during pregnancy and post-partum? Let's dive in.

Precision Medicine and Integrative Medicine for Mental Health

Personalized, or precision medicine, involves utilizing genetic information, biomarkers, and technology to determine personalized treatment decisions for people. Integrative medicine is a holistic approach to health, taking into consideration both conventional psychiatric treatments (like medication and therapy), as well as other treatments such as mind-body practices, supplements, nutrition, lifestyle, and spirituality. So when we combine personalized and integrative medicine, we really can individualize treatment that is not only effective but also aligned with a patient's values.

Hormones, Inflammation, and Depression during Pregnancy

Levels of the hormones, estradiol and progesterone increase throughout pregnancy and are higher than pre-pregnancy levels. Estradiol and progesterone rapidly decrease after delivery and that rapid estrogen withdrawal has been linked to anxiety and depression during the post-partum period. However, hormones are much more complicated than that; estrogen has also been shown to increase inflammatory markers and pro-inflammatory activity is also associated with depression. There is still a lot that is unknown.

The Microbiome as a Biomarker for Perinatal Mental Health

The diversity of the microbiome has an impact on immune response and levels of inflammation. Dysbiosis, or a shift towards more disease-causing microbes and less diversity in the gut, is associated with mental health conditions such as anxiety and depression. With dysbiosis, there is an increased risk of losing an intact intestinal barrier. When the intestinal barrier is no longer intact, bacteria can get into the blood circulation which activates the immune response and produces pro-inflammatory cytokines. This is often called "leaky gut". Dysbiosis can also reduce levels of estrogen in the bloodstream, which could further contribute to mood symptoms.