title: Altered functioning of the HPA axis in depressed postpartum women.
abstract: BACKGROUND
  The present study aimed to evaluate the relationship between the functioning of the hypothalamic-pituitary-adrenal (HPA) axis and major depressive episodes in the remote postpartum period.
  
  
  METHODS
  The sample (mean age, 28.0±5.3 years) consisted of 37 depressed postpartum women (DPP), 42 euthymic postpartum women (EPP) and 25 non-postpartum healthy women (HC). Salivary cortisol samples were collected immediately after awakening and 30min, 3 and 12h later, at approximately the sixth month postpartum (mean, 169.6±60.3 days).
  
  
  RESULTS
  Differences in cortisol levels were observed at awakening (DPP<EPP=HC), at 30min (DPP<EPP<HC), at 3h (DPP=EPP<HC) and at 12h (DPP>EPP=HC). The relative increment in the cortisol awakening response (CARi%) was significantly higher in HC (113.5±94.3) than in EPP (63.1±69.8) and DPP (32.2±49.6). The relative reduction in diurnal variation (DVr%) was lower in DPP (56.5±41.8) than in EPP (75.6±22.4) and HC (75.1±13.0).
  
  
  CONCLUSIONS
  The main limitation was cortisol collection on a single day and without measurement at midnight.
  
  
  CONCLUSIONS
  Our findings suggest that the remote postpartum period involves attenuation of HPA axis reactivity; this dysregulation is more pronounced in the presence of DPP, which is associated with a reduction in cortisol diurnal variation. Abnormalities in the neuroendocrine system related to stress processing, present even several months after delivery, can represent vulnerability to mental disorders. Thus, improvements in the mental health care of postpartum women are needed.
authors.affiliation: Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil. Electronic address: rezendemarcos@yahoo.com.br.
authors.forename: Marcos Gonçalves
authors.initials: MG
authors.lastname: de Rezende
authors.affiliation: Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Cybele
authors.initials: C
authors.lastname: Garcia-Leal
authors.affiliation: Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Felipe Pinheiro
authors.initials: FP
authors.lastname: de Figueiredo
authors.affiliation: Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Ricardo de Carvalho
authors.initials: Rde C
authors.lastname: Cavalli
authors.affiliation: Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Maristela Schaufelberger
authors.initials: MS
authors.lastname: Spanghero
authors.affiliation: Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Barbieri
authors.affiliation: Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Heloisa
authors.initials: H
authors.lastname: Bettiol
authors.affiliation: Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Margaret
authors.initials: M
authors.lastname: de Castro
authors.affiliation: Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Cristina Marta
authors.initials: CM
authors.lastname: Del-Ben
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002940:Circadian Rhythm / Q000502:physiology; D003527:Cyclothymic Disorder / Q000503:physiopathology; D019052:Depression, Postpartum / Q000503:physiopathology*; D003865:Major Depressive Disorder / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012463:Saliva / Q000737:chemistry; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: Cortisol awakening response; Cortisol diurnal variation; Depression; Hypothalamic–pituitary–adrenal (HPA) axis; Postpartum; Puerperium