title: Tryptophan pathway alterations in the postpartum period and in acute postpartum psychosis and depression.
abstract: OBJECTIVE
  Women are at very high risk for the first onset of acute and severe mood disorders the first weeks after delivery. Tryptophan breakdown is increased as a physiological phenomenon of the postpartum period and might lead to vulnerability for affective psychosis (PP) and severe depression (PD). The aim of the current study was to investigate alterations in tryptophan breakdown in the physiological postpartum period compared to patients with severe postpartum mood disorders.
  
  
  METHODS
  We included 52 patients (29 with PP, 23 with PD), 52 matched healthy postpartum women and 29 healthy non-postpartum women. Analyzes of serum tryptophan metabolites were performed using LC-MS/MS system for tryptophan, kynurenine, 3-hydroxykynurenine, kynurenic acid and 5-hydroxyindoleacetic acid.
  
  
  RESULTS
  The first two months of the physiological postpartum period were characterized by low tryptophan levels, increased breakdown towards kynurenine and a downstream shift toward the 3-OH-kynurenine arm, away from the kynurenic acid arm. Kynurenine was significantly lower in patients with PP and PD as compared to healthy postpartum women (p=0.011 and p=0.001); the remaining tryptophan metabolites demonstrated few differences between patients and healthy postpartum women.
  
  
  CONCLUSIONS
  Low prevalence of the investigated disorders and strict exclusion criteria to obtain homogenous groups, resulted in relatively small sample sizes.
  
  
  CONCLUSIONS
  The high kynurenine levels and increased tryptophan breakdown as a phenomenon of the physiological postpartum period was not present in patients with severe postpartum mood disorders. No differences were observed in the levels of the 'neurotoxic' 3-OH-kynurenine and the 'neuroprotective' kynurenic acid arms between patients and healthy postpartum women.
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, 's Gravendijkwal 230, Rotterdam, The Netherlands. Electronic address: c.veen@erasmusmc.nl.
authors.forename: Cato
authors.initials: C
authors.lastname: Veen
authors.affiliation: School for Mental Health and Neuroscience, University of Maastricht, Maastricht, The Netherlands.
authors.forename: Aye Mu
authors.initials: AM
authors.lastname: Myint
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, 's Gravendijkwal 230, Rotterdam, The Netherlands.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Burgerhout
authors.affiliation: Institute for Laboratory Medicine of Munich University, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Schwarz
authors.affiliation: Institute for Laboratory Medicine of Munich University, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Schütze
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, 's Gravendijkwal 230, Rotterdam, The Netherlands.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kushner
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, 's Gravendijkwal 230, Rotterdam, The Netherlands.
authors.forename: Witte J
authors.initials: WJ
authors.lastname: Hoogendijk
authors.affiliation: Department of Immunology, Erasmus University Medical Centre, 's Gravendijkwal 230, Rotterdam, The Netherlands.
authors.forename: Hemmo A
authors.initials: HA
authors.lastname: Drexhage
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, 's Gravendijkwal 230, Rotterdam, The Netherlands; National Center for Register-Based Research, Aarhus School of Business and Social Sciences Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark.
authors.forename: Veerle
authors.initials: V
authors.lastname: Bergink
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000097:blood / Q000378:metabolism*; D005260:Female; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000097:blood; D007736:Kynurenic Acid / Q000097:blood; D007737:Kynurenine / Q000031:analogs & derivatives / Q000097:blood; D049590:Postpartum Period / Q000097:blood / Q000378:metabolism*; D011618:Psychotic Disorders / Q000097:blood / Q000378:metabolism*; D011644:Puerperal Disorders / Q000097:blood / Q000378:metabolism*; D053719:Tandem Mass Spectrometry; D014364:Tryptophan / Q000378:metabolism*; D055815:Young Adult
chemical_list: C005045:3-hydroxykynurenine; D007737:Kynurenine; D006897:Hydroxyindoleacetic Acid; D014364:Tryptophan; D007736:Kynurenic Acid
keywords: Depression; Immunology; Kynurenine; Postpartum; Psychosis; Serotonin; Tryptophan