Depression is often under-diagnosed and untreated during routine medical care for pregnancy. Stress and depression during pregnancy can result in poor nutrition, substance abuse and risk of suicide for the mother, as well as preterm delivery, birth complications and miscarriage.
Further evidence associates untreated depression following birth with marital disruption, low self-esteem, maternal withdrawal, disengagement and hostility affecting the mother-infant relationship. Furthermore, it is important to diagnose and treat depression because of its strong association with long-term impaired cognitive, emotional, physical and behavioural development of the child.
The inflammatory effects of stress are so significant that a direct causal link or significant association with miscarriage and IVF-assisted reproductive failure have been found in epidemiological studies.
A review study of drug treatment options for women during pregnancy raises safety concerns regarding the known adverse effects and lack of long-term studies of foetus and infant exposure to medication. All classes of prescription drugs for depression have side effects including popular SSRI and SNRI antidepressant drugs. This is an area of current research and doctors are advised to keep up to date with the latest findings on a monthly basis.
Researchers now understand that depression is not simply a psychological condition, but one which can be triggered by physical inflammation in the body.
The psychological and behavioural symptoms of depression such as fatigue, numbness, loss of appetite and motivation are actually part of the body’s complex response to a physical infection.
“Inflammation explains why many social, emotional, behavioural and physical risk factors increase the risk of depression.”
Patients with major depression have higher levels of inflammatory cytokines, which have been found to interact with almost every pathway known to be involved with depression in the brain.
Cytokines are small protein molecules in blood that play a major role in the activation and cell-to-cell communication of the immune system. They can be pro-inflammatory or anti-inflammatory, depending on the sum of their effects within the body. Pro-inflammatory cytokines stimulate an immune response which helps the body to fight infection, heal wounds as well as respond to stress.
Women are especially vulnerable to depression during pregnancy because their levels of pro-inflammatory cytokines rise significantly during the last trimester. The same cytokines which ripen the cervix are also elevated in patients with depression (IL-1β, IL-6 and TNF-α). Increased stress during and post pregnancy has also been shown to raise these cytokine levels even further.
Within normal levels they help to prevent infection, however, abnormally high levels are associated with depressive symptoms including changes in sleep, appetite, mood, energy and social activity.
The systems that normally regulate inflammation are also disrupted by depression. Cortisol is one of the most potent anti-inflammatory hormones in the body regulated by the HPA axis. Depressed people have low levels of cortisol or their body becomes desensitised to its anti-inflammatory effects.
Depression can become a vicious cycle at the cellular level too because inflammation increases the risk of depression and depression further increases inflammation.
The insertion of fine needles into the skin at specific points creates a micro-injury that triggers a cascade of immune, inflammatory and nervous responses.
There are several pathways in which acupuncture has been shown to inhibit the immune response, through direct and indirect effects on cell-signalling neuropeptides, cytokine production and inhibition, as well as dilation of blood vessels.
More specifically, acupuncture stimulation of the vagus nerve which connects the organs with the brain can directly inhibit the production of IL-1β, IL-6, TNF and other pro-inflammatory cytokines. Furthermore, long term acupuncture treatments can increase levels of anti-inflammatory (IL-10) cytokines.
While there is no single theory that can explain the many therapeutic effects of acupuncture, studies to date have shown that it can reset the imbalance between pro-inflammatory and anti-inflammatory cytokines to control inflammation.
A rigorously conducted, blinded randomised controlled trial by Stanford University School of Medicine researchers found that pregnant women with major depressive disorder who received depression-specific acupuncture experienced a 63% reduction in symptoms compared with a 44% reduction for groups receiving control acupuncture and massage treatment combined.
This information in this article has been informed by the following scientific research papers. If you have any questions, please share and discuss these findings with your doctor or healthcare professional.
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