Born to have Baby Blues?

Mother In Nursery Suffering From Post Natal DepressionIt’ s not clear what causes postpartum depression.  The condition, which is marked by persistent feelings of sadness, hopelessness, exhaustion and anxiety, usually begins within four weeks of giving birth and can persist for weeks, months or even up to a year. An estimated 10 to 18% of all new mothers develop the condition, and the rate rises to 30 to 35% among women with previously diagnosed mood disorders.

Scientists have long believed the symptoms were related to the large drop-off in the mother’s estrogen levels following childbirth, however studies have shown that both depressed and non-depressed women have similar estrogen levels.

Now researchers from Johns Hopkins say they have discovered alterations in two genes that, can reliably predict whether a woman will develop postpartum depression.

genetic link to post-partum depressionThe genetic modifications, which alter the way genes function without changing the underlying DNA sequence, can apparently be detected in the blood of pregnant women during any trimester, potentially providing a simple way to foretell depression in the weeks after giving birth, and an opportunity to intervene before symptoms become debilitating.

By studying mice, the researchers suspected that estrogen induced genetic changes in cells of the hippocampus – the part of the brain that governs mood.  They  then created a complicated statistical model to find the candidate which could be potential predictors for postpartum depression. That process resulted in the identification of two genes, known as TTC9B and HP1BP3.

Little is known about these genes except for their involvement in hippocampal activity. However the team suspects that they may have something to do with the creation of new cells in the hippocampus and the ability of the brain to reorganize and adapt in the face of new environments. Both of these elements are known to be important in mood.

Furthermore, estrogen can behave like an antidepressant, so when it is inhibited, it adversely affects mood.

Postpartum depression can be harmful to both mother and child,” says Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “But we don’t have a reliable way to screen for the condition before it causes harm, and a test like this could be that way.”

The findings of the small study involving 52 pregnant women are described online in the journal Molecular Psychiatry.

blood  test + pregnancyThe study involved looking for epigenetic changes tin the thousands of genes present in blood samples from 52 pregnant women with mood disorders. The women were followed both during and after pregnancy to see who developed postpartum depression.

The researchers noticed that women who developed postpartum depression exhibited stronger changes in those genes that are most responsive to estrogen, suggesting that these women are more sensitive to the hormone’s effects. Specifically, changes to the two genes – TTC9B and predicted with 85% certainty which women became ill.

We were pretty surprised by how well the genes were correlated with postpartum depression,” Kaminsky says. “With more research, this could prove to be a powerful tool.”

Evidence suggests that early identification and treatment of postpartum depression can limit or prevent debilitating effects. Alerting women to the condition’s risk factors — as well as determining whether they have a previous history of the disorder, other mental illness and unusual stress — is key to preventing long-term problems.

Research also shows that postpartum depression not only affects the health and safety of the mother, but also her child’s mental, physical and behavioral health.

antidepressants.pregnancy.giIf the results of this preliminary work pan out then a blood test for the biomarkers could be added to the battery of tests women already undergo during pregnancy.  More importantly, the results could help to inform decisions about the use of antidepressants. While there are concerns about the effects of these drugs on the fetus and their use should be weighed against the potentially debilitating consequences to both the mother and child of forgoing them.

As Kaminsky says “If you knew you were likely to develop postpartum depression, your decisions about managing your care could be made more clearly.”

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The Ultimate Life Test?

Imagine a simple blood test that could tell you if you’re going to die. Would that be super cool or super scary?  Well, imagine no more, it turns out there is such a test.

Researchers at McMaster University have found a test that can identify people who are at high risk of dying in the month after surgery.  Apparently elevated levels of troponin T (a protein marker of heart injury) correlate with an increased risk of death.

Currently, troponin levels are not commonly measured after most types of surgery.

The results from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study, the largest international prospective study evaluating complications after surgery, have just been published in the Journal of the American Medical Association (JAMA).

VISION enrolled 15,133 adult patients in North and South America, Asia, Australia, and Europe.  Troponin T was measured daily during the first three days after surgery. Patients were followed while in the hospital and at 30 days after surgery.

VISION demonstrated that a simple blood test strongly identifies which non-cardiac surgery patients are at high risk of dying in the next 30 days,” said Dr. P.J. Devereaux, VISION principal investigator.

According to Devereaux the results also demonstrated that most patients did not die until an average of six or more days after their troponin T blood test was identified as elevated. “This holds out great hope that there is time to intervene.”

Knowing who is at risk through the test can help physicians target patients who need enhanced observation or interventions.

Surgery activates pathways of inflammation, stress, and clotting that predispose the heart to injury. As a result, many patients suffer heart attacks after surgery. The majority of these patients, however, will not experience chest pain. Evidence from this study supports experts who have advocated the use of troponin blood tests after surgery.

The VISION study suggests that myocardial injury detected through elevated troponin T may explain 42% of deaths that occur after surgery.

This study has substantial potential to change how patients are monitored after surgery,” said Dr. Jean Rouleau, scientific director of the Institute for Circulatory and Respiratory Health of the Canadian Institutes of Health Research. “These results hold substantial promise that through measuring troponin blood tests after surgery, physicians can identify which patients are at high-risk of dying and this can allow them to consider enhanced monitoring and interventions in an attempt to improve outcomes. This is a good example of how a carefully conducted clinical study can impact  patient care.”

SRxA’s Word on Health would like to know if you would take the test.