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Ten to 15 percent of women across the globe suffer from a depressive disorder and eight to ten per cent of women experience anxiety during pregnancy and the postpartum period. One of the front line treatments for these women is medication, in particular the type known as selective serotonin reuptake inhibitors (SSRIs) and doses are usually higher for pregnant and postpartum women because the body doesn’t absorb drugs as well during those times. As well as postpartum depression and anxiety, SSRIs are also prescribed for conditions such as postpartum dysthymia, panic disorder, and obsessive-compulsive disorder.

SSRIs work by increasing serotonin in the brain though the way that happens is still unclear.  While serotonin typically rises during pregnancy, a study out of Norway found that a decrease in serotonin in pregnant women perhaps due to depression or anxiety, can increase her child’s risk for developing attention deficit hyperactivity disorder (ADHD). Studies have found one of the potential causes of postpartum depression and anxiety to be low levels of serotonin.

Joseph Lonstein, a professor in the Neuroscience Program and Department of Psychology at Michigan State University wrote a review recently published in the Archives of Women’s Mental Health which examined the existing scientific literature on SSRIs and their effects on pregnant and postpartum women. Lonstein found that due to a lack of research on SSRIs for females, little is known about the effect of SSRIs in women across the maternal spectrum. Not much is known either about the transference of SSRIs to the infant through breast milk.

“There are very few studies about this,” Lonstein told us. “I first discuss the extremely few studies indicating that a woman's serotonin system changes during pregnancy and postpartum and then discuss the more (but still few) studies from my lab and others showing that many aspects of this system change across reproduction in laboratory animals.” 

Lonstein believes this topic is important because a tremendous number of women are prescribed and are taking selective serotonin reuptake inhibitors (SSRIs) during pregnancy and postpartum that partly target the brain’s serotonin system. 

Pregnant and postpartum women have long been given SSRIs without considering any unique aspects about their brain serotonin system. If they were better studied and known, there could be implications for optimizing the timing and doses of SSRIs in order to target when they’re most effective on the reproducing brain and reduce side effects for both the mother and fetus/infant.

“The female brain, whether in a reproducing state or not, is not the same as the male brain,” Lonstein told us. “There are hundreds of sex differences that, while some are small, have implications for typical and atypical brain function.”

Lonstein says these differences also have implications for using drugs targeting those systems in males and females.  Even if the basic sex differences are considered, the pregnant and postpartum female brain has even further changed when compared to the non-reproductive female brain. 

"It’s surely difficult to consider all of these possibilities (male, female, reproducing female), but absolutely critical for properly treating psychopathology and surely many other mental and physical ailments in women," Lonstein told us.

Federal funding agencies in the U.S. and Canada have made important strides in recent years to help ensure that their funded human and animals research involves both adult males and females whenever possible.  However, Lonstein notes that 'female' is not a homogeneous group and more recognition of the changes in the brain occurring across pregnancy, postpartum, and beyond in mothers is essential for understanding their mental and physical health. 

"Even more recognition is needed to establish the idea into the research and medical fields that females are not males, and that female brains are not even a single, unchanging organ."