—Pregnancy and the birth of a baby can trigger many emotions – excitement, joy, fear – but can also be a time that women find themselves unexpectedly beset by depression. Affecting as many as 15% of women who bear children, postpartum depression has received significant attention in the media recently, with actresses Brooke Shields and Courtney Cox sharing their struggles with the condition. Mary Jo Codey, wife of New Jersey’s acting governor Richard J. Codey also publicly discussed experiencing severe depression following childbirth.

In addition to the impact depression has on a woman’s emotional and physical wellbeing, research suggests that if left untreated, severe depression during pregnancy and in the postpartum period may have negative consequences for the developing fetus and newborn baby. However, drugs taken during these periods may be shared with a fetus through the placenta, or a nursing baby through the mother’s breast milk. The potential effects of these medications also need to be fully understood in order to make the best treatment decisions for both mother and child. NARSAD researchers studying pregnancy and postpartum depression seek to better understand the causes for these conditions, effects of both depression and drug therapies on a developing child, and ways in which depression may interfere with a woman’s ability to care for her infant.

Prevention of Postpartum Depression
Kelly Louise Minor, Ph.D., Stanford University (2005 Young Investigator), is studying postpartum depression from the perspective of prevention. Dr. Minor will identify women who are at high risk for developing postpartum depression, and treat them with a combination of group interpersonal psychotherapy (IPT) and cognitive behavior therapy (CBT). She believes that these combined therapies for depression will reduce major depressive episodes during the first three months following delivery. Pregnant women will be considered at increased risk if they have any one of the following risk factors – current mild or moderate depression, a past history of depression, or poor social support. Poor social support would include a limited involvement by the baby's father or a difficult marital situation. Participants in the study will be randomly assigned to groups, with some receiving the combined group-therapy, with others receiving standard treatments for depression. Diagnostic interviews and questionnaires will be used to evaluate the group therapy’s effectiveness. After the results are collected, those participants who did not receive the four sessions of group therapy will be invited to do so. In an effort to predict the therapy’s longer-term effectiveness, six months after giving birth all participants will be asked to complete questionnaires to measure changes in risk factors, the stability of their moods, and symptoms of depression at that time.

Brain Abnormalities in Infants with Prenatal Maternal Depression
A researcher studying the effects of a pregnant mother’s depression on her developing fetus is Deana B. Davalos, Ph.D., Denver Research Center (2005 Young Investigator). Depression during pregnancy can in itself be devastating for the woman experiencing it, but is often accompanied by difficult decisions regarding drug treatment options and the possible consequences for both herself and her baby. Despite research suggesting that almost one in ten women suffer from clinical depression during pregnancy, prepartum maternal depression is a condition that has not been well studied and whose possible effects on a developing fetus are poorly understood. Limited research suggests that deficits may be present in infants of whose mothers’ were clinically depressed during pregnancy. However, it is not clear whether the use of antidepressant medications reduces these deficits or leads to even greater physiological problems. Dr. Davalos’ preliminary data suggest that the use of antidepressants during the prenatal period may improve infants’ performance on at least one index associated with higher cognitive development. She and her team plan to measure the effects of maternal depression and medication on synaptic brain function in infants. Dr. Davalos hopes that this research will shed light on the effects a mother’s depression during pregnancy has on her infant, and lead to increased recognition of the need to identify and treat depression as part of prenatal care.

Mothers Responding To Infant Cries: Childcare and Postpartum Depression
Throughout the animal kingdom many mammals cry out as infants, with mothers generally responding promptly to care for their young. In humans, the basis in the brain for mothering is not well understood. Samet Kose, M.D., Medical University of South Carolina (2003 Young Investigator) seeks to better understand human mothering behaviors. To accomplish this goal, his team has been using functional MRI (fMRI) imaging technology to compare brain activity in depressed and non-depressed mothers listening to the sound of an infant’s cries. Prior research has found that many brain regions important in rodent maternal behavior also display activity in mothers listening to a crying baby. In humans, these brain regions are important in motivation and attention – and also show changes in activity in depressed individuals. Depression can interfere with a mother's ability to bond with her baby, and studies have shown that depressed mothers rate infant cries as less urgent than do healthy mothers. It is Dr. Kose’s hypothesis that compared to healthy mothers, depressed mothers will show altered activity in these brain regions when they listen to an infant crying. The findings from this research will add to our understanding of altered maternal mood states and may provide a method for diagnosing postpartum depression.