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3 years ago

Karen Amaral Tavares Pinheiro - Universidade Católica de Pelotas

Karen Amaral Tavares Pinheiro - Universidade Católica de Pelotas

104 Conclusions

104 Conclusions Clinicians should enquire postpartum women about their history of stressful life events, PPAD, and suicidality. This study shows the potential role of BDNF in the neurobiology of association of PPAD and suicidality. This may contribute in psychiatryclinical decisions. Significant outcomes: 1. The BDNF levels are significantly low only in those women with PPAD and suicidality. 2. There were no difference, in this sample, between the BDNF levels and the different types of PPAD episodes (depression, mania, mixed) when associated with suicidality. 3. Stressful life events on gestational period were associated with low levels of BDNF in postpartum. Limitations 1. The cross-sectional design, in which BDNF is measured at one time point, limits inferences about causality 2. Low statistical power unable us to make adequate generalizations to other disorders beyond PPAD in association with suicidality in this sample. 3. No specific biological measure of stress was used. Keywords: postpartum affective disorder, suicidality, serum brain-derived neurotrophic factor (BDNF)

105 Introduction The postpartum period is a time of increased risk of new-onset psychiatric illness for new mothers, and the most serious consequence of this risk is a corresponding high risk of infanticide and suicide in women presenting postpartum affective disorders 1 . Moreover, it has been proposed that the cumulative impact of several factors, including stressful life events (SLEs), may play a role in the incidence of postpartum affective disorders (PPADs) 2 . PPADs are an important public health concern, particularly when it involves suicide attempts 3 . Prevalence of high suicide risk have varied from 4% to more than 15% 4 . Indeed, we have demonstrated that postpartum women with depression have an increased risk of suicidality, which is a behavior or attitude that suggests suicidal ideation 3 . The neurochemical mechanisms involved in suicidality are complex, but the putative role of neurotrophins has consistently been considered. Reduced brain-derived neurotrophic factor (BDNF) expression has been implicated in the neurobiology of stress and affective disorders, which are contributory factors in suicidal behavior 2,5,6,7 . Moreover, lower BDNF expression in the blood samples of individuals with suicidal risk 8 ) and in the postmortem brain tissue of people who committed suicide support the belief that the brain modulatory functions exerted by this neurotrophin could be disrupted and could affect suicide behavior 9,10,11 . Overall, BDNF expression is often reduced in humans with neuropsychiatric disorders and in animal models of neuropsychiatric disorders 5,12,13 . Although this evidence suggests that BDNF might play an integrative role in the neurobiological basis of neuropsychiatric disorders, its involvement in PPADs has received little attention. The main objective of this work was to understand the neuropsychiatric and biological factors that contribute to the risk of suicidal behavior in postpartum period. Thus, we

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