Neuroendocrinology of Perinatal Mental Illness

Mental illness during pregnancy and the postpartum period is a growing health crisis. We know that at least 1 in 7 women during the perinatal period will experience a mood or anxiety disorder such as perinatal depression (PND) or general anxiety disorder. These mental illnesses significantly impact the well-being of the mother, as well as how she interacts with her infant and family. Over the past 10 years there has been a growing need to understand the neuroendocrine mechanisms mediating perinatal mental illness. Much of this research has focused on aspects of the hypothalamic-pituitary-adrenal (HPA) and -gonadal (HPG) axes and thus this chapter will focus on these two systems in perinatal mental illness. This chapter will review our current understanding of the neuroendocrinology of perinatal mental illness from research in women and animal models, with a focus on PND and anxiety, but will also consider the limited data we have for other perinatal mental illnesses such as postpartum psychosis and childbirth-related post-traumatic stress disorder. We have much research to do to fully understand the mechanisms behind these disorders and will discuss options for future research. Increased understanding of the unique neuroendocrine profiles associated with perinatal mental illness will allow us to predict risk, develop effective treatments and, ultimately, prevent suffering for millions of mothers during this critical time in life.