Explanation of Postpartum Depression and Postpartum Psychosis

I first published this idea to a number of internet newsgroups September 15, 1997. I recently found a new citation (end) that further supports my idea, so I decided to add the citation and publish my idea again.

My principle hypothesis is that DHEA acts to optimize transcription and replication of DNA. Therefore, my theory suggests that DHEA is involved in the functions of every cell, tissue, organ, body, and can be seen in populations. Therefore, levels of DHEA will affect such phenomena as labor and mental function.

DHEA is provided for the mother and fetus from the adrenal glands of the mother. The adrenal glands of the infant do not start producing DHEA until birth. This means that the DHEA provided by the mother must provide for all of her tissues and the fetus. At the first pregnancy, DHEA decreases significantly in the mother (J. Clin. Endocrin. Metab. 1987: 64: 111). (In 1985, because of my principle hypothesis, I proposed that low DHEA will result in depression and Alzheimer's disease (copyrighted, 1985). In 1997, DHEA was used in "six middle-aged and elderly patients with major depression and low basal plasma DHEA." These investigators found that: "In both studies, improvements in depression ratings and memory performance were directly related to increases in plasma levels of DHEA and DHEA-S and to increases in their ratios with plasma cortisol levels. These preliminary data suggest that DHEA may have antidepressant and promemory effects and should encourage double-blind trials in depressed patients." (Biol. Psychiatry 1997; 41: 311)

So, in mothers of low DHEA who give birth, according to my theory, one would expect to find depression. A posting at a bulletin board mentioned that a number of women, with whom the person had experience, who required oxytocin (pitocin) for birth, exhibited postpartum depression and infanticide. This area also fits my explanation, because use of oxytocin for labor actually increases DHEA, in low DHEA women.

"RESULTS: Oxytocin augmentation followed standard indications in 29 of the 55 patients. The mean maternal DHEA sulfate level was significantly lower in these patients than in the remaining 26 who progressed spontaneously through labor.
CONCLUSION: Among term nulliparous women, maternal serum levels of DHEA sulfate are significantly lower in those clinically requiring pharmacologic augmentation than in those progressing spontaneously through labor."

The following quotation, from 1998, adds further support that women who have difficult labor may have difficulty due to low DHEA. The conclusion of the report is that: "Dehydroepiandrosterone sulfate may be an important factor in successful labor induction." Above, I mentioned my explanation of depression as a result of low DHEA. One may read my explanation of schizophrenia, as a result of low DHEA, at this web page. Psychotic behaviors also may occur in Alzheimer's disease and AIDS, both of which exhibit low DHEA. I suggest that the coincidence of postpartum depression and psychosis in some women following birth, especially in those who have difficult labor, is due to low DHEA in these women.

"OBJECTIVE: To evaluate the maternal serum dehydroepiandrosterone (DHEA) sulfate level as a factor associated with the outcome of labor induction.
METHODS: Venous blood was collected from 161 women at the initiation of labor induction. Pregnancies complicated by maternal corticosteroid use, antepartum chorioamnionitis, or cesarean delivery for indications other than arrest disorders were excluded from analysis. In 155 women meeting inclusion criteria, induction followed established protocols. Serum DHEA sulfate levels were measured by radioimmunoassay and correlated with the outcome of each induction attempt. A success was defined as progression to active labor. The Welch approximate t test, Mann-Whitney test, Fisher exact test, simple regression, and multiple regression were used for statistical analysis, with P < .05 considered significant.
RESULTS: The mean (+/- standard error) DHEA sulfate level was higher in women who progressed to active labor (n = 147) than in those with unsuccessful attempts (n = 8), (109.01 +/- 5.19 microg/dL versus 58.78 +/- 15.83 microg/dL, respectively; P = .02). Compared with women with DHEA sulfate levels above 70 microg/dL, women with lower levels had an unsuccessful induction odds ratio (OR) of 4.46 (95% confidence interval, 1.12, 17.67; P = .04). The OR increased as DHEA sulfate levels decreased.
CONCLUSION: Dehydroepiandrosterone sulfate may be an important factor in successful labor induction." Obstet. Gynecol. 1998; 91: 771

Childhood Depression and DHEA

Psychol. Med. 1998; 28: 265"Adrenal steroid secretion and major depression in 8- to 16-year-olds, III. Influence of cortisol/DHEA ratio at presentation on subsequent rates of disappointing life events and persistent major depression" Goodyer IM, Herbert J, Altham PM, Department of Psychiatry, University of Cambridge

"BACKGROUND: An investigation of the association between diurnal changes in cortisol and DHEA levels, or in the cortisol/DHEA ratio at five different time points at presentation, and the occurrence of undesirable life events (losses, dangers to self and others, disappointments) during follow-up, and the outcome of major depression at 36 weeks were investigated.
METHODS: Psychosocial and endocrine assessment of a consecutive cohort (N = 68) of 8- to 16-year-old subjects with first episode major depression reassessed 12 months after presentation using a repeat measures design.
RESULTS: Higher cortisol/DHEA ratios at 20.00 or 24.00 h predicted persistent major depression. Basal levels of either hormone alone or cortisol/DHEA ratios at the other three time points (08.00, 12.00 or 16.00 h) did not. High cortisol/DHEA ratios (i.e. values greater than the 60th percentile) at both evening points (20.00 and 24.00 h) also predicted the occurrence of subsequent disappointing life events but no other category of undesirable event. Both high evening cortisol/DHEA ratio at 20.00 h and one or more severely disappointing life events between presentation and follow-up predicted persistent major depression: 86% of subjects with both of these factors were still depressed at 36 weeks whereas 81% with neither factor were not.
CONCLUSIONS: The finding that it is depressed subjects with high cortisol/DHEA ratios at presentation who are specifically at risk for subsequent disappointing life events suggests a putative role for these adrenal steroids in abnormal cognitive or emotional processes associated with disturbed interpersonal behaviour."