Conventional and new immunotherapies for immune system dysregulation in postpartum mood disorders: comparisons to immune system dysregulations in bipolar disorder, major depression, and postpartum autoimmune thyroid disease.

TitleConventional and new immunotherapies for immune system dysregulation in postpartum mood disorders: comparisons to immune system dysregulations in bipolar disorder, major depression, and postpartum autoimmune thyroid disease.
Publication TypeJournal Article
Year of Publication2025
AuthorsDrexhage HA, Bergink V, Poletti S, Benedetti F, Osborne LM
JournalExpert Rev Clin Immunol
Volume21
Issue2
Pagination113-135
Date Published2025 Feb
ISSN1744-8409
KeywordsAnimals, Bipolar Disorder, Depression, Postpartum, Depressive Disorder, Major, Female, Humans, Immunotherapy, Mood Disorders, Postpartum Period, Pregnancy, Thyroiditis, Autoimmune
Abstract

INTRODUCTION: Postpartum mood disorders are heterogenous disorders and comprise postpartum psychosis and postpartum depression. Evidence is accumulating that systemic monocyte/macrophage activation, low-grade inflammation and (premature senescence related) T cell defects increase the risk for mood disorders outside pregnancy by affecting the function of microglia and T cells in the emotional brain (the cortico-limbic system) leading to inadequate mood regulation upon stress.

AREAS COVERED: The evidence in the literature that similar immune dysregulations are present in postpartum mood disorders.

RESULTS: The physiological postpartum period is characterized by a rapid T cell surge and a mild activation of the monocyte/macrophage system. Postpartum mood disorder patients show a diminished T cell surge (including that of T regulatory cells) and an increase in low grade inflammation, that is, an increased inflammatory state of monocytes/macrophages and higher levels of serum pro-inflammatory cytokines.

EXPERT OPINION: Anti-inflammatory agents (e.g. COX-2 inhibitors) and T cell boosting agents (e.g. low-dose IL-2 therapy) should be further investigated as treatment. The hypothesis should be investigated that postpartum mood disorders are active episodes (triggered by changes in the postpartum immuno-endocrine milieu) in ongoing, dynamically fluctuating aberrant neuro-immune-endocrine trajectories leading to mood disorders in women (inheritably) vulnerable to these disorders.

DOI10.1080/1744666X.2024.2420053
Alternate JournalExpert Rev Clin Immunol
PubMed ID39441185
PubMed Central IDPMC11786996
Grant ListR01 MH122869 / MH / NIMH NIH HHS / United States
R01 MH124776 / MH / NIMH NIH HHS / United States