title: HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression.
abstract: It is unclear whether women with a history of postpartum depression (PPD) have residual, abnormal hypothalamic-pituitary-adrenal (HPA) axis reactivity, as has been reported in major depression (MDD). Further unclear is whether the abnormalities in HPA axis reactivity associated with MDD represent a stable, underlying predisposition or a state-dependent phenomenon. This study sought the following: (1) to determine if euthymic postpartum women with a history of depression have an abnormal HPA axis reactivity to pharmacologic and psychological challenges and (2) to compare HPA reactivity in women with histories of PPD versus MDD. As a secondary objective, we wanted to determine the influence of trauma history on HPA axis function. Forty-five parous (12-24 months postpartum), euthymic women with history of MDD (n = 15), PPD (n = 15), and controls (n = 15) completed pharmacologic (dexamethasone/corticotropin-releasing hormone (CRH) test [DEX/CRH]) and psychological (Trier social stress test [TSST]) challenges during the luteal phase. Outcome measures were cortisol and adrenocorticotropic hormone (ACTH) response after DEX/CRH, and blood pressure, heart rate, epinephrine, norepinephrine, and cortisol response during the TSST. All groups had robust cortisol and ACTH response to DEX/CRH and cortisol response to TSST. Groups did not differ significantly in cortisol or ACTH response to DEX/CRH or in blood pressure, heart rate, epinephrine, norepinephrine, or cortisol response to TSST. Cortisol/ACTH ratio did not differ significantly between groups. Trauma history was associated with decreased cortisol response to DEX/CRH in women with histories of MDD, which was not significant after correction (F8,125, p = 0.02, Greenhouse-Geisser corrected p = 0.11). Currently euthymic women with histories of MDD or PPD did not demonstrate residual abnormal stress responsivity following administration of either a pharmacologic or psychological stressor.
authors.affiliation: Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA. eferguso@bcm.edu.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Ferguson
authors.affiliation: Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.|Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
authors.forename: Arianna
authors.initials: A
authors.lastname: Di Florio
authors.affiliation: Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Pearson
authors.affiliation: Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.
authors.forename: Karen T
authors.initials: KT
authors.lastname: Putnam
authors.affiliation: Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Girdler
authors.affiliation: Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Rubinow
authors.affiliation: Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Meltzer-Brody
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000503:physiopathology* / Q000523:psychology*; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*
keywords: Cortisol; Dexamethasone/corticotropin-releasing hormone test; HPA axis; Major depressive disorder; Postpartum depression; Trier social stress test