3 years ago

Karen Amaral Tavares Pinheiro - Universidade Católica de Pelotas

Karen Amaral Tavares Pinheiro - Universidade Católica de Pelotas

110 treatment and SLEs

110 treatment and SLEs in pregnancy the BDNF levels of women with PPADs and suicidality were reduced in -0.912(CI -1.73 – 0.09). In the adjusted Poisson regression, PPADs and suicide risk showed a risk of 10.73 (CI 2.09 – 55.03) for lower serum BDNF level (Table 2). Discussion The neuropsychological and neurobiochemical changes implicated in the neurobiology of PPADs have emerged as possible biological targets for therapeutic and preventive interventions to prevent PPAD mothers from attempting suicide. In this study, we found that serum BDNF levels were significantly lower in women with PPADs presenting suicide risk compared to women without suicide risk. Additionally, women with three or more SLEs during pregnancy exhibited reduced serum BDNF levels, whereas women experiencing two SLEs did not. Several lines of evidence suggest that BDNF may play a role in psychiatric disorders; for example, pharmacological interventions that improve psychiatric symptoms also increase BDNF expression 9,16 . Previous studies have reported that BDNF expression was lower in subjects exposed to SLEs, in subjects experiencing affective disorders and in suicidal individuals 17 , but the potential implication of these events on BDNF expression in postpartum women had not yet been explored. In our study, BDNF levels were not able to discriminate PPADs (depression, manic and mixed episode) from non-PPAD women (data not shown). Similarly, Kim et al. proposed that plasma BDNF is not a good marker of major depression (an affective disorder) but is associated with an increase in suicidal behavior 10 . In accordance with this proposal, here we showed that lower serum BDNF levels were associated with suicide risk in PPAD women (Figure 1A). Our finding is further substantiated by previous brain postmortem studies that show significantly lower BDNF levels and reduced RNA expression of BDNF's cognate receptor tyrosine kinase B receptor in the hippocampus and

111 prefrontal cortices of suicide victims compared with both psychiatric patients who have not attempted suicide and control subjects 18,19 . Despite the high lifetime rate of suicide, most people with depression never attempt suicide. This fact raises the question as to why some people with depression are at risk for attempting suicide and others are not 10 . Considering that various clinical and epidemiological studies have identified stressors as an important risk factor for suicide, we additionally investigated whether SLEs during pregnancy influence BDNF levels. By regression analysis, three or more SLEs correlated with smaller differences in BDNF levels than did suicide risk (three- and eight-fold changes in risk, respectively). However, we do not discount the clinical relevance of SLEs as a factor that influences suicidal behavior. Indeed, alterations in the stress system (particularly hyperactivation of the HPA axis) are well documented in suicide victims and in depressed suicide attempters who subsequently complete suicide. However, time between the suicide attempt and the examination could account for the differences reported in some studies 20,21,22,23 . Furthermore, several arguments suggest that suicidal behavior is a disorder of its own, although psychiatric disturbances (such as depression) are major contributing factors. The presence of psychopathology is a strong predictor of suicide; however, there is a certain predisposition to suicide that is independent of the main psychiatric disorders 5 . Considering the variety of psychological events and biological changes that occur during the course of a pregnancy, it is reasonable to believe that factors beyond SLEs and PPADs may be affecting BDNF levels and suicide risk. Thus, further investigation is required to determine whether the observed differences in serum BDNF levels are specifically related to either mental disorders or suicide risk during the perinatal period. Several studies have proposed that impaired structural and functional plasticity are involved in the molecular and cellular events that lead to psychiatric disorders, such as mood disorders and suicidal behavior. Support for this theory

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