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Regulation of mRNA expression encoding chaperone and co-chaperone proteins of the glucocorticoid receptor in peripheral blood: association with depressive symptoms during pregnancy

Published online by Cambridge University Press:  14 October 2011

E. R. Katz ,
Z. N. Stowe ,
D. J. Newport ,
M. E. Kelley ,
T. W. Pace ,
J. F. Cubells  and
E. B. Binder
E. R. Katz
Affiliation:
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
Z. N. Stowe
Affiliation:
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA Emory University School of Medicine, Department of Obstetrics and Gynecology, Atlanta, GA, USA
D. J. Newport
Affiliation:
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
M. E. Kelley
Affiliation:
Rollins School of Public Health, Department of Biostatistics and Bioinformatics Atlanta GA, USA
T. W. Pace
Affiliation:
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
J. F. Cubells
Affiliation:
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA Emory University School of Medicine, Department of Human Genetics, Atlanta, GA, USA
E. B. Binder*
Affiliation:
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA Max Planck Institute of Psychiatry, Munich, Germany
*
*Address for correspondence: E. B. Binder, MD PhD, Max-Planck Institute of Psychiatry, Kraepelinstr. 2–10, 80804 Munich, Germany. (Email: [email protected])
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Abstract

Background

Major depressive disorder during pregnancy associates with potentially detrimental consequences for mother and child. The current study examined peripheral blood gene expression as a potential biomarker for prenatal depressive symptoms.

Method

Maternal RNA from whole blood, plasma and the Beck Depression Inventory were collected longitudinally from preconception through the third trimester of pregnancy in 106 women with a lifetime history of mood or anxiety disorders. The expression of 16 genes in whole blood involved in glucorticoid receptor (GR) signaling was assessed using real-time polymerase chain reaction. In parallel, plasma concentrations of progesterone, estradiol and cortisol were measured. Finally, we assessed ex vivo GR sensitivity in peripheral blood cells from a subset of 29 women.

Results

mRNA expression of a number of GR-complex regulating genes was up-regulated over pregnancy. Women with depressive symptoms showed significantly smaller increases in mRNA expression of four of these genes – FKBP5, BAG1, NCOA1 and PPID. Ex vivo stimulation assays showed that GR sensitivity diminished with progression of pregnancy and increasing maternal depressive symptoms. Plasma concentrations of gonadal steroids and cortisol did not differ over pregnancy between women with and without clinically relevant depressive symptoms.

Conclusions

The presence of prenatal depressive symptoms appears to be associated with altered regulation of GR sensitivity. Peripheral expression of GR co-chaperone genes may serve as a biomarker for risk of developing depressive symptoms during pregnancy. The presence of such biomarkers, if confirmed, could be utilized in treatment planning for women with a psychiatric history.

Keywords

Co-chaperonegene expressionglucocorticoid receptorperipartum depressionperipheral bloodsteroid hormones
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 5 , May 2012 , pp. 943 - 956
Copyright
Copyright © Cambridge University Press 2011

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References

Akesson, A, Bjellerup, P, Berglund, M, Bremme, K, Vahter, M (1998). Serum transferrin receptor: a specific marker of iron deficiency in pregnancy. American Journal of Clinical Nutrition 68, 1241–1246.CrossRefGoogle ScholarPubMed
Allolio, B, Hoffmann, J, Linton, EA, Winkelmann, W, Kusche, M, Schulte, HM (1990). Diurnal salivary cortisol patterns during pregnancy and after delivery: relationship to plasma corticotrophin-releasing-hormone. Clinical Endocrinology 33, 279–289.CrossRefGoogle ScholarPubMed
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Bimston, D, Song, J, Winchester, D, Takayama, S, Reed, JC, Morimoto, RI (1998). BAG-1, a negative regulator of Hsp70 chaperone activity, uncouples nucleotide hydrolysis from substrate release. EMBO Journal 17, 6871–6878.CrossRefGoogle ScholarPubMed
Bloch, M, Daly, RC, Rubinow, DR (2003). Endocrine factors in the etiology of postpartum depression. Comprehensive Psychiatry 44, 234–246.CrossRefGoogle ScholarPubMed
Brennan, PA, Pargas, R, Walker, EF, Green, P, Jeffrey Newport, D, Stowe, Z (2008). Maternal depression and infant cortisol: influences of timing, comorbidity and treatment. Journal of Child Psychology and Psychiatry 49, 1099–1107.CrossRefGoogle ScholarPubMed
Brett, K, Barfield, W (2008). Prevalence of self-reported postpartum depressive symptoms. In Morbidity and Mortality Weekly Report, 11 April. Center for Disease Control: Atlanta, GA.Google Scholar
Brummelte, S, Galea, LA (2009). Depression during pregnancy and postpartum: contribution of stress and ovarian hormones. Progress in Neuro-Psychopharmacology and Biological Psychiatry 34, 766–776.CrossRefGoogle ScholarPubMed
Bunevicius, R, Kusminskas, L, Mickuviene, N, Bunevicius, A, Pedersen, CA, Pop, VJ (2009). Depressive disorder and thyroid axis functioning during pregnancy. World Journal of Biological Psychiatry 10, 324–329.CrossRefGoogle ScholarPubMed
Burke, KC, Burke, Jr. JD, Rae, DS, Regier, DA (1991). Comparing age at onset of major depression and other psychiatric disorders by birth cohorts in five US community populations. Archives of General Psychiatry 48, 789–795.CrossRefGoogle ScholarPubMed
Carr, BR, Parker, CR Jr., Madden, JD, MacDonald, PC, Porter, JC (1981). Maternal plasma adrenocorticotropin and cortisol relationships throughout human pregnancy. American Journal of Obstetrics and Gynecology 139, 416–422.CrossRefGoogle ScholarPubMed
Cheadle, C, Vawter, MP, Freed, WJ, Becker, KG (2003). Analysis of microarray data using Z score transformation. Journal of Molecular Diagnostics 5, 73–81.CrossRefGoogle ScholarPubMed
Choi, JW, Im, MW, Pai, SH (2000). Serum transferrin receptor concentrations during normal pregnancy. Clinical Chemistry 46, 725–727.CrossRefGoogle ScholarPubMed
Clark, PM (1998). Programming of the hypothalamo-pituitary-adrenal axis and the fetal origins of adult disease hypothesis. European Journal of Pediatrics 157 (Suppl. 1), S7–S10.CrossRefGoogle ScholarPubMed
Cox, JL, Murray, D, Chapman, G (1993). A controlled study of the onset, duration and prevalence of postnatal depression. British Journal of Psychiatry 163, 27–31.CrossRefGoogle ScholarPubMed
Davies, TH, Ning, YM, Sanchez, ER (2002). A new first step in activation of steroid receptors: hormone-induced switching of FKBP51 and FKBP52 immunophilins. Journal of Biological Chemistry 277, 4597–4600.CrossRefGoogle ScholarPubMed
DeRijk, RH, Petrides, J, Deuster, P, Gold, PW, Sternberg, EM (1996). Changes in corticosteroid sensitivity of peripheral blood lymphocytes after strenuous exercise in humans. Journal of Clinical Endocrinology and Metabolism 81, 228–235.Google ScholarPubMed
Duncan, MR, Duncan, GR (1979). An in vivo study of the action of antiglucocorticoids on thymus weight ratio, antibody titre and the adrenal-pituitary-hypothalamus axis. Journal of Steroid Biochemistry 10, 245–259.CrossRefGoogle Scholar
Evans, J, Heron, J, Francomb, H, Oke, S, Golding, J (2001). Cohort study of depressed mood during pregnancy and after childbirth. British Medical Journal 323, 257–260.CrossRefGoogle ScholarPubMed
Evans, LM, Myers, MM, Monk, C (2008). Pregnant women's cortisol is elevated with anxiety and depression – but only when comorbid. Archives of Women's Mental Health 11, 239–248.CrossRefGoogle ScholarPubMed
Field, T, Diego, MA, Hernandez-Reif, M, Figueiredo, B, Ascencio, A, Schanberg, S, Kuhn, C (2008). Prenatal dysthymia versus major depression effects on maternal cortisol and fetal growth. Depression and Anxiety 25, E11–E16.CrossRefGoogle ScholarPubMed
First, M, Spitzer, R, Gibbon, M, Williams, J (1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P, Version 2.0). NY State Psychiatric Institute, Biometrics Research Dept: New York.Google Scholar
Gavin, NI, Gaynes, BN, Lohr, KN, Meltzer-Brody, S, Gartlehner, G, Swinson, T (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics and Gynecology 106, 1071–1083.CrossRefGoogle ScholarPubMed
Goland, RS, Jozak, S, Warren, WB, Conwell, IM, Stark, RI, Tropper, PJ (1993). Elevated levels of umbilical cord plasma corticotropin-releasing hormone in growth-retarded fetuses. Journal of Clinical Endocrinology and Metabolism 77, 1174–1179.Google ScholarPubMed
Gotlib, IH, Whiffen, VE, Wallace, PM, Mount, JH (1991). Prospective investigation of postpartum depression: factors involved in onset and recovery. Journal of Abnormal Psychology 100, 122–132.CrossRefGoogle ScholarPubMed
Grad, I, Picard, D (2007). The glucocorticoid responses are shaped by molecular chaperones. Molecular and Cellular Endocrinology 275, 2–12.CrossRefGoogle ScholarPubMed
Greenwood, J, Parker, G (1984). The dexamethasone suppression test in the puerperium. Australian and New Zealand Journal of Psychiatry 18, 282–284.CrossRefGoogle ScholarPubMed
Holsboer, F (2000). The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology 23, 477–501.CrossRefGoogle ScholarPubMed
Holsboer, F, Barden, N (1996). Antidepressants and hypothalamic-pituitary-adrenocortical regulation. Endocrine Reviews 17, 187–205.CrossRefGoogle ScholarPubMed
Hubler, TR, Denny, WB, Valentine, DL, Cheung-Flynn, J, Smith, DF, Scammell, JG (2003). The FK506-binding immunophilin FKBP51 is transcriptionally regulated by progestin and attenuates progestin responsiveness. Endocrinology 144, 2380–2387.CrossRefGoogle ScholarPubMed
Hubler, TR, Scammell, JG (2004). Intronic hormone response elements mediate regulation of FKBP5 by progestins and glucocorticoids. Cell Stress Chaperones 9, 243–252.CrossRefGoogle ScholarPubMed
Iga, J, Ueno, S, Yamauchi, K, Numata, S, Kinouchi, S, Tayoshi-Shibuya, S, Song, H, Ohmori, T (2007). Altered HDAC5 and CREB mRNA expressions in the peripheral leukocytes of major depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry 31, 628–632.CrossRefGoogle ScholarPubMed
Jaaskelainen, T, Makkonen, H, Palvimo, JJ (2011). Steroid up-regulation of FKBP51 and its role in hormone signaling. Current Opinion in Pharmacology 11, 326–331.CrossRefGoogle ScholarPubMed
Ji, S, Long, Q, Newport, DJ, Na, H, Knight, B, Zach, EB, Morris, NJ, Kutner, M, Stowe, ZN (2010). Validity of depression rating scales during pregnancy and the postpartum period: impact of trimester and parity. Journal of Psychiatric Research 45, 213–219.CrossRefGoogle ScholarPubMed
Kammerer, M, Taylor, A, Glover, V (2006). The HPA axis and perinatal depression: a hypothesis. Archives of Women's Mental Health 9, 187–196.CrossRefGoogle ScholarPubMed
Karalis, K, Goodwin, G, Majzoub, JA (1996). Cortisol blockade of progesterone: a possible molecular mechanism involved in the initiation of human labor. Nature Medicine 2, 556–560.CrossRefGoogle ScholarPubMed
Karlen, Y, McNair, A, Perseguers, S, Mazza, C, Mermod, N (2007). Statistical significance of quantitative PCR. BMC Bioinformatics 8, 131.CrossRefGoogle ScholarPubMed
Keller-Wood, M, Silbiger, J, Wood, CE (1988). Progesterone attenuates the inhibition of adrenocorticotropin responses by cortisol in nonpregnant ewes. Endocrinology 123, 647–651.CrossRefGoogle ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Kimmins, S, MacRae, TH (2000). Maturation of steroid receptors: an example of functional cooperation among molecular chaperones and their associated proteins. Cell Stress Chaperones 5, 76–86.2.0.CO;2>CrossRefGoogle ScholarPubMed
King, NM, Chambers, J, O'Donnell, K, Jayaweera, SR, Williamson, C, Glover, VA (2010). Anxiety, depression and saliva cortisol in women with a medical disorder during pregnancy. Archives of Women's Mental Health 13, 339–345.CrossRefGoogle ScholarPubMed
Kullmann, M, Schneikert, J, Moll, J, Heck, S, Zeiner, M, Gehring, U, Cato, AC (1998). RAP46 is a negative regulator of glucocorticoid receptor action and hormone-induced apoptosis. Journal of Biological Chemistry 273, 14620–14625.CrossRefGoogle ScholarPubMed
Kumar, P, Mark, PJ, Ward, BK, Minchin, RF, Ratajczak, T (2001). Estradiol-regulated expression of the immunophilins cyclophilin 40 and FKBP52 in MCF-7 breast cancer cells. Biochemical and Biophysical Research Communications 284, 219–225.CrossRefGoogle ScholarPubMed
Kurihara, I, Shibata, H, Suzuki, T, Ando, T, Kobayashi, S, Hayashi, M, Saito, I, Saruta, T (2000). Transcriptional regulation of steroid receptor coactivator-1 (SRC-1) in glucocorticoid action. Endocrine Research 26, 1033–1038.CrossRefGoogle ScholarPubMed
Lowy, MT, Reder, AT, Antel, JP, Meltzer, HY (1984). Glucocorticoid resistance in depression: the dexamethasone suppression test and lymphocyte sensitivity to dexamethasone. American Journal of Psychiatry 141, 1365–1370.Google ScholarPubMed
Lowy, MT, Reder, AT, Gormley, GJ, Meltzer, HY (1988). Comparison of in vivo and in vitro glucocorticoid sensitivity in depression: relationship to the dexamethasone suppression test. Biological Psychiatry 24, 619–630.CrossRefGoogle Scholar
McLean, M, Bisits, A, Davies, J, Woods, R, Lowry, P, Smith, R (1995). A placental clock controlling the length of human pregnancy. Nature Medicine 1, 460–463.CrossRefGoogle ScholarPubMed
Marcus, S, Lopez, JF, McDonough, S, Mackenzie, MJ, Flynn, H, Neal, Jr. CR, Gahagan, S, Volling, B, Kaciroti, N, Vazquez, DM (2010). Depressive symptoms during pregnancy: impact on neuroendocrine and neonatal outcomes. Infant Behavior and Development 34, 26–34.CrossRefGoogle ScholarPubMed
Mathers, CD, Loncar, D (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3, e442.CrossRefGoogle ScholarPubMed
Meaney, MJ, Szyf, M, Seckl, JR (2007). Epigenetic mechanisms of perinatal programming of hypothalamic-pituitary-adrenal function and health. Trends in Molecular Medicine 13, 269–277.CrossRefGoogle ScholarPubMed
Meijer, OC, Kalkhoven, E, van der Laan, S, Steenbergen, PJ, Houtman, SH, Dijkmans, TF, Pearce, D, de Kloet, ER (2005). Steroid receptor coactivator-1 splice variants differentially affect corticosteroid receptor signaling. Endocrinology 146, 1438–1448.CrossRefGoogle ScholarPubMed
Meltzer-Brody, S, Stuebe, A, Dole, N, Savitz, D, Rubinow, D, Thorp, J (2010). Elevated corticotropin releasing hormone (CRH) during pregnancy and risk of postpartum depression (PPD). Journal of Clinical Endocrinology and Metabolism 96, E40–E47.CrossRefGoogle ScholarPubMed
Miller, GE, Rohleder, N, Stetler, C, Kirschbaum, C (2005). Clinical depression and regulation of the inflammatory response during acute stress. Psychosomatic Medicine 67, 679–687.CrossRefGoogle ScholarPubMed
Morishima, Y, Kanelakis, KC, Silverstein, AM, Dittmar, KD, Estrada, L, Pratt, WB (2000). The Hsp organizer protein hop enhances the rate of but is not essential for glucocorticoid receptor folding by the multiprotein Hsp90-based chaperone system. Journal of Biological Chemistry 275, 6894–6900.CrossRefGoogle Scholar
O'Hara, MW, Neunaber, DJ, Zekoski, EM (1984). Prospective study of postpartum depression: prevalence, course, and predictive factors. Journal of Abnormal Psychology 93, 158–171.CrossRefGoogle ScholarPubMed
O'Hara, MW, Rehm, LP, Campbell, SB (1983). Postpartum depression. A role for social network and life stress variables. Journal of Nervous and Mental Disease 171, 336–341.CrossRefGoogle ScholarPubMed
O'Hara, MW, Schlechte, JA, Lewis, DA, Varner, MW (1991). Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables. Journal of Abnormal Psychology 100, 63–73.CrossRefGoogle ScholarPubMed
O'Hara, MW, Zekoski, EM, Philipps, LH, Wright, EJ (1990). Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. Journal of Abnormal Psychology 99, 3–15.CrossRefGoogle ScholarPubMed
O'Keane, V, Lightman, S, Marsh, M, Pawlby, S, Papadopoulos, AS, Taylor, A, Moore, R, Patrick, K (2010). Increased pituitary-adrenal activation and shortened gestation in a sample of depressed pregnant women: a pilot study. Journal of Affective Disorders 130, 300–305.CrossRefGoogle Scholar
Odunuga, OO, Longshaw, VM, Blatch, GL (2004). Hop: more than an Hsp70/Hsp90 adaptor protein. Bioessays 26, 1058–1068.CrossRefGoogle ScholarPubMed
Oretti, RG, Hunter, C, Lazarus, JH, Parkes, AB, Harris, B (1997). Antenatal depression and thyroid antibodies. Biological Psychiatry 41, 1143–1146.CrossRefGoogle ScholarPubMed
Paakinaho, V, Makkonen, H, Jaaskelainen, T, Palvimo, JJ (2010). Glucocorticoid receptor activates poised FKBP51 locus through long-distance interactions. Molecular Endocrinology 24, 511–525.CrossRefGoogle ScholarPubMed
Pariante, CM (2004). Glucocorticoid receptor function in vitro in patients with major depression. Stress 7, 209–219.CrossRefGoogle ScholarPubMed
Pariante, CM, Miller, AH (2001). Glucocorticoid receptors in major depression: relevance to pathophysiology and treatment. Biological Psychiatry 49, 391–404.CrossRefGoogle Scholar
Patel, FA, Challis, JR (2002). Cortisol/progesterone antagonism in regulation of 15-hydroxysteroid dehydrogenase activity and mRNA levels in human chorion and placental trophoblast cells at term. Journal of Clinical Endocrinology and Metabolism 87, 700–708.CrossRefGoogle ScholarPubMed
Paykel, ES, Emms, EM, Fletcher, J, Rassaby, ES (1980). Life events and social support in puerperal depression. British Journal of Psychiatry 136, 339–346.CrossRefGoogle ScholarPubMed
Ramakers, C, Ruijter, JM, Deprez, RH, Moorman, AF (2003). Assumption-free analysis of quantitative real-time polymerase chain reaction (PCR) data. Neuroscience Letters 339, 62–66.CrossRefGoogle ScholarPubMed
Ratajczak, T, Ward, BK, Minchin, RF (2003). Immunophilin chaperones in steroid receptor signalling. Current Topics in Medicinal Chemistry 3, 1348–1357.CrossRefGoogle ScholarPubMed
Robinson, BG, Emanuel, RL, Frim, DM, Majzoub, JA (1988). Glucocorticoid stimulates expression of corticotropin-releasing hormone gene in human placenta. Proceedings of the National Academy of Sciences 85, 5244–5248.CrossRefGoogle ScholarPubMed
Rothenberger, SE, Resch, F, Doszpod, N, Moehler, E (2011). Prenatal stress and infant affective reactivity at five months of age. Early Human Development 87, 129–136.CrossRefGoogle ScholarPubMed
Rousseau, GG, Baxter, JD, Tomkins, GM (1972). Glucocorticoid receptors: relations between steroid binding and biological effects. Journal of Molecular Biology 67, 99–115.CrossRefGoogle ScholarPubMed
Schneikert, J, Hubner, S, Langer, G, Petri, T, Jaattela, M, Reed, J, Cato, AC (2000). Hsp70-RAP46 interaction in downregulation of DNA binding by glucocorticoid receptor. EMBO Journal 19, 6508–6516.CrossRefGoogle ScholarPubMed
Segman, RH, Goltser-Dubner, T, Weiner, I, Canetti, L, Galili-Weisstub, E, Milwidsky, A, Pablov, V, Friedman, N, Hochner-Celnikier, D (2010). Blood mononuclear cell gene expression signature of postpartum depression. Molecular Psychiatry 15, 93–100.CrossRefGoogle ScholarPubMed
Smith, R, Nicholson, RC (2007). Corticotrophin releasing hormone and the timing of birth. Frontiers in Bioscience 12, 912–918.CrossRefGoogle ScholarPubMed
Smith, R, Owens, PC, Brinsmead, MW, Singh, B, Hall, C (1987). The nonsuppressibility of plasma cortisol persists after pregnancy. Hormone and Metabolic Research 19, 41–42.CrossRefGoogle Scholar
Talge, NM, Neal, C, Glover, V (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? Journal of Child Psychology and Psychiatry 48, 245–261.CrossRefGoogle ScholarPubMed
Tang, PZ, Gannon, MJ, Andrew, A, Miller, D (1995). Evidence for oestrogenic regulation of heat shock protein expression in human endometrium and steroid-responsive cell lines. European Journal of Endocrinology 133, 598–605.CrossRefGoogle ScholarPubMed
U, M, Shen, L, Oshida, T, Miyauchi, J, Yamada, M, Miyashita, T (2004). Identification of novel direct transcriptional targets of glucocorticoid receptor. Leukemia 18, 1850–1856.CrossRefGoogle ScholarPubMed
Üstün, TB, Ayuso-Mateos, J-L, Chatterji, S, Mathers, C, Murray, CJL (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry 184, 386–392.CrossRefGoogle ScholarPubMed
van den Bergh, BR, van Calster, B, Smits, T, van Huffel, S, Lagae, L (2008). Antenatal maternal anxiety is related to HPA-axis dysregulation and self-reported depressive symptoms in adolescence: a prospective study on the fetal origins of depressed mood. Neuropsychopharmacology 33, 536–545.CrossRefGoogle ScholarPubMed
Vermeer, H, Hendriks-Stegeman, BI, van Suylekom, D, Rijkers, GT, van Buul-Offers, SC, Jansen, M (2004). An in vitro bioassay to determine individual sensitivity to glucocorticoids: induction of FKBP51 mRNA in peripheral blood mononuclear cells. Molecular and Cellular Endocrinology 218, 49–55.CrossRefGoogle Scholar
Wisner, KL, Stowe, ZN (1997). Psychobiology of postpartum mood disorders. Seminars in Reproductive Endocrinology 15, 77–89.CrossRefGoogle ScholarPubMed
Yonkers, KA, Vigod, S, Ross, LE (2011). Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. Obstetrics and Gynecology 118, 708–709.CrossRefGoogle Scholar
Zonana, J, Gorman, JM (2005). The neurobiology of postpartum depression. CNS Spectrums 10, 792–799, 805.CrossRefGoogle ScholarPubMed