Background
Accumulating evidence suggests that dysregulation of the immune system represents
an important vulnerability factor for mood disorders. Postpartum psychosis (PP) is
a severe mood disorder occurring within 4 weeks after delivery, a period of heightened
immune responsiveness and an altered endocrine set point. Therefore, the aim of this
study was to examine immune activation in patients with first-onset PP at the level
of monocytes, T cells, and serum cytokines/chemokines.
Methods
We included 63 women admitted with first-onset PP. Control groups included healthy
postpartum (n = 56) and nonpostpartum (n = 136) women. A quantitative-polymerase chain reaction monocyte gene expression analysis
was performed with 43 genes previously identified as abnormally regulated in nonpostpartum
mood disorder patients including the isoforms of the glucocorticoid receptor. Peripheral
blood mononuclear cells percentages were measured by fluorescence-activated cell sorter
analysis, whereas serum cytokines/chemokines were determined with a cytometric bead
array.
Results
In healthy women, postpartum T cell levels were significantly elevated compared with
nonpostpartum. Patients with PP failed to show the normal postpartum T cell elevation.
In contrast, these patients showed a significant elevation of monocyte levels and
a significant upregulation of several immune-related monocyte genes compared with
control subjects postpartum and nonpostpartum. Furthermore, the glucocorticoid receptor
α/β gene expression ratio was decreased in monocytes of PP patients, strongly correlating
with their immune activation.
Conclusions
This study demonstrates a robust dysregulation of the immuno-neuro-endocrine set point
in PP, with a notable over-activation of the monocyte/macrophage arm of the immune
system.
Key Words
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Article info
Publication history
Published online: December 27, 2012
Accepted:
November 1,
2012
Received in revised form:
October 18,
2012
Received:
November 30,
2011
Identification
Copyright
© 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
