The Role of Hormones in Postpartum Mood Disorders

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2014 by National Institutes of Health Clinical Center (CC)
Sponsor:
Information provided by:
National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier:
NCT00001481
First received: November 3, 1999
Last updated: March 27, 2014
Last verified: March 2014
  Purpose

Determine whether postpartum depression is triggered by the abrupt withdrawal of estrogen and progesterone.

The appearance of mood and behavioral symptoms during pregnancy and the postpartum period has been extensively reported. While there has been much speculation about possible biologically based etiologies for postpartum disorders (PPD), none has ever been confirmed. Preliminary results from two related studies (protocols 90-M-0088, 92-M-0174) provide evidence that women with menstrual cycle related mood disorder, but not controls, experience mood disturbances during exogenous replacement of physiologic levels of gonadal steroids. The present protocol is designed to create a "scaled-down" hormonal milieu of pregnancy and the puerperium in order to determine whether women who have had a previous episode of postpartum major effective episode will experience differential mood and behavioral effects compared with controls and to determine whether it is the abrupt withdrawal of gonadal steroids or the prolonged exposure to gonadal steroids that is associated with mood symptoms. Supraphysiologic plasma levels of gonadal steroids will be established, maintained, and then rapidly reduced, simulating the hormonal events that occur during pregnancy and parturition. This will be accomplished by administering estradiol and progesterone to women who are pretreated with a gonadotropin releasing hormone (GnRH) agonist (Lupron). After eight weeks, administration of gonadal steroids will be stopped in one group of patients and controls, and a sudden decline in the plasma hormone levels will be precipitated. Another group will be maintained on supraphysiologic levels of estrogen and progesterone for an additional month. Outcome measures will include mood, behavioral and hormonal parameters as well as response to o-CRH (a separate protocol done in collaboration with NICHD).


Condition
Depressive Disorder
Mood Disorder
Postpartum Depression
Depression

Study Type: Observational
Official Title: An Endocrine Model for Postpartum Mood Disorders

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Estimated Enrollment: 80
Study Start Date: March 1995
Detailed Description:

The appearance of mood and behavioral symptoms during pregnancy and the postpartum period has been extensively reported. While there has been much speculation about possible biologically based etiologies for postpartum disorders (PPD), none has ever been confirmed. Preliminary results from two related studies (protocols 90-M-0088, 92-M-0174) provide evidence that women with menstrual cycle related mood disorder, but not controls, experience mood disturbances during exogenous replacement of physiologic levels of gonadal steroids. The present protocol is designed to create a "scaled-down" hormonal milieu of pregnancy and the puerperium in order to determine whether women who have had a previous episode of postpartum major affective episode will experience differential mood and behavioral effects compared with controls and to determine whether it is the abrupt withdrawal of gonadal steroids or the prolonged exposure to gonadal steroids that is associated with mood symptoms. Supraphysiologic plasma levels of gonadal steroids will be established, maintained, and then rapidly reduced, simulating the hormonal events that occur during pregnancy and parturition. This will be accomplished by administering estradiol and progesterone to women who are pretreated with a gonadotropin releasing hormone (GnRH) agonist (Lupron). After eight weeks, administration of gonadal steroids will be stopped in one group of patients and controls, and a sudden decline in the plasma hormone levels will be precipitated. Another group will be maintained on supraphysiologic levels of estradiol and progesterone for an additional month. Outcome measures will include mood, behavioral and hormonal parameters as well as response to o-CRH.

  Eligibility

Ages Eligible for Study:   18 Years to 50 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria
  • INCLUSION CRITERIA:

A. Group 1: Women with a history of postpartum depression:

  1. A history of DSM-IV major depression or hypomanic/manic episode that occurred within three months of childbirth (as determined by a SCID interview);
  2. has been well for a minimum of one year;
  3. a regular menstrual cycle for at least three months;
  4. age 18-50;
  5. not pregnant, not lactating and in good medical health;
  6. medication free (including birth control pills);
  7. no history of puerperal suicide attempts or psychotic episodes requiring hospitalization.

Group 2: Women with a history of Major Depressive Disorder

  1. A history of DSM-IV major depression episode(s) occurring outside of pregnancy and not within three months postpartum;
  2. has been well for a minimum of one year;
  3. a regular menstrual cycle for at least three months;
  4. age 18-50;
  5. not pregnant, not lactating and in good medical health;
  6. medication free (including birth control pills);
  7. no history of suicide attempts or psychotic episodes requiring hospitalization.

Group 3; Normal Controls

  1. Controls will meet all criteria specified except they must not have any past or present Axis I diagnosis or evidence of menstrually related mood disorders.
  2. A structured clinical interview for DSM-IV (SCID) will be administered to all women prior to study entry. Any woman with a current axis I psychiatric diagnosis will be excluded from participating in this protocol.

    EXCLUSION CRITERIA:

    Patients will not be permitted to enter this protocol if they have important clinical or laboratory abnormalities including any history of the following:

    endometriosis;

    undiagnosed enlargement of the ovaries;

    liver disease;

    breast cancer;

    a history of blood clots in the legs or lungs;

    undiagnosed vaginal bleeding;

    porphyria;

    diabetes mellitus;

    malignant melanoma;

    gallbladder or pancreatic disease;

    heart or kidney disease;

    cerebrovascular disease (stroke);

    cigarette smoking;

    a history of suicide attempts or psychotic episodes requiring hospitalization;

    recurrent migraine headaches;

    pregnancy (patients will be warned not to become pregnant during the study and will be advised to employ barrier contraceptive methods;

    pregnancy-related medical conditions such as hyperemesis gravidarum, pretoxemia and toxemia, deep vein thrombosis (DVT) and bleeding diathesis;

    Any woman with a first degree relative (immediate family) with premenopausal breast cancer or breast cancer presenting in both breasts or any woman who has multiple family members (greater than three relatives) with postmenopausal breast cancer will also be excluded from participating in this protocol;

    Any woman meeting the Stages of Reproductive Aging Workshop Criteria (STRAW) for the perimenopause will be excluded from participation. Specifically, we will exclude any woman with an elevated plasma FSH level (greater than or equal to14 IU/L) and with menstrual cycle variability of > 7 days different from their normal cycle length.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00001481

Contacts
Contact: Pedro E Martinez, M.D. (301) 496-5831 martinep@mail.nih.gov

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL)    800-441-1222 ext TTY8864111010    prpl@mail.cc.nih.gov   
Sponsors and Collaborators
Investigators
Principal Investigator: Pedro E Martinez, M.D. National Institute of Mental Health (NIMH)
  More Information

Additional Information:
Publications:
ClinicalTrials.gov Identifier: NCT00001481     History of Changes
Other Study ID Numbers: 950097, 95-M-0097
Study First Received: November 3, 1999
Last Updated: March 27, 2014
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Postpartum Disorders
Postpartum Depression
Postpartum
Depression
Mood
Hormones
Pregnancy
Estrogen
Progesterone
Gonadal Steroids
GnRH Agonist
Mood Disorder

Additional relevant MeSH terms:
Depression
Depressive Disorder
Disease
Mood Disorders
Depression, Postpartum
Behavioral Symptoms
Mental Disorders
Pathologic Processes
Puerperal Disorders
Pregnancy Complications

ClinicalTrials.gov processed this record on September 30, 2014