Citation

Moses-Kolko EL, Horner MS, Phillips ML, Hipwell AE, Swain JE. J. Neuroendocrinol. 2014; 26(10): 665-684.

Affiliation

Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.

Copyright

(Copyright © 2014, John Wiley and Sons)

DOI

10.1111/jne.12183

PMID

25059408

Abstract

This is a selective review which provides the context for study of perinatal affective disorder mechanisms and outlines directions for future research. We integrate existing literature (Table) along neural networks of interest for affective disorders and maternal caregiving: 1) the salience/fear network, 2) the executive network, 3) the reward/social attachment network, and 4) the default mode network. Extant salience/fear network research reveals disparate responses and corticolimbic coupling to various stimuli based upon a predominantly depressive versus anxious (posttraumatic stress disorder, PTSD) clinical phenotype. Executive network and default mode connectivity abnormalities have been described in postpartum depression (PPD), but studies are very limited in these domains. Reward/Social attachment studies confirm a robust ventral striatal response to infant stimuli including cry and happy infant faces, which is diminished in depressed, insecurely attached, and substance-using mothers. Adverse parenting experiences received and attachment insecurity of current mothers are factors which are associated with diminution in infant stimulus-related neural activity similar to than in PPD, and raise the need for additional studies that integrate mood and attachment concepts in larger study samples. Several studies which have examined functional connectivity in resting state and emotional activation functional magnetic resonance imaging (fMRI) paradigms have revealed attenuated corticolimbic connectivity which remains an important outcome to dissect with increasing precision to better define neural treatment targets.

METHODological progress is expected in the coming years in terms of refining clinical phenotypes of interest and experimental paradigms as well as enlarging samples to facilitate examination of multiple constructs. Functional imaging promises to elucidate neural mechanisms underlying maternal psychopathology and impaired caregiving such that earlier and more precise detection of abnormalities will be possible. Ultimately, discovery of such mechanisms will promote refinement of treatment approaches toward maternal affective disturbance, parenting behaviors as well as augmentation of parenting resiliency. This article is protected by copyright. All rights reserved.

Language: en