Gut Microbiota in Postpartum Depression: Pathogenesis and Treatment Perspectives - a review
DOI:
https://doi.org/10.12775/JEHS.2025.82.60357Keywords
Gut microbiota, Postpartum depression (PPD)Abstract
Introduction and purpose: Postpartum depression (PPD) is a prevalent and serious mood disorder following childbirth, affecting approximately 10-20% of new mothers worldwide. PPD not only impacts a mother’s mental health but also her relationship with her infant, her family, and the psychosocial development of the child. While numerous factors (genetic, hormonal, psychosocial, immunological) contribute to its pathogenesis, growing evidence underscores the central importance of the gut-brain axis and gut microbiota dysbiosis. This article aims to summarise current knowledge on crucial role of gut microbiota in the onset, progression and therapeutic possibilities of PPD.
Description of the state of knowledge: Gut microbes influence PPD through the gut-brain axis, impacting neuroendocrine systems, immune responses, and neurotransmitter production. In particular, alterations in gut microbiota composition such as reduced levels of short-chain fatty acid-producing bacteria and an increased abundance of pro-inflammatory taxa have been linked to immune dysregulation, heightened stress responses, and altered neurotransmitter metabolism in PPD. Studies show that microbial dysbiosis correlate with PPD symptoms, while interventions like probiotics and dietary changes offer promising therapeutic avenues.
Summary: This review summarizes current evidence on the gut–brain axis in depression, observed gut microbiota changes in PPD, mechanistic pathways linking dysbiosis to postpartum mood disturbances, and emerging microbiota-targeted therapies, including probiotics and fecal microbiota transplantation (FMT).
References
1. O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407
2. Howard LM, Molyneaux E, Dennis CL et al. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384:1775–88
3. Forty L, Jones L, Macgregor S et al. Familiality of postpartum depression in unipolar disorder: results of a family study. Am J Psychiatry. 2006;163:1549–53
4. Zhang S, Lu B, Wang G. The role of gut microbiota in the pathogenesis and treatment of postpartum depression. Ann Gen Psychiatry 2023;22:36
5. Farías-Antúnez S, Xavier MO, Santos IS. Effect of maternal postpartum depression on offspring’s growth. J Affect Disord. 2018;228:143–52
6. Netsi E, Pearson RM, Murray L et al. Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiat. 2018;75:247–53
7. Oh Y, Joung YS, Baek JH et al. Maternal depression trajectories and child executive function over 9 years. J Affect Disord. 2020;276:646–52
8. Goodman SH, Rouse MH, Connell AM et al. Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev. 2011;14:1–27
9. Hellgren C, Åkerud H, Skalkidou A et al. Low serum allopregnanolone is associated with symptoms of depression in late pregnancy. Neuropsychobiology. 2014;69:147–53
10. Zou Y, Fan F, Ma A et al. Hormonal changes and somatopsychologic manifestations in the first trimester of pregnancy and post partum. Int J Gynaecol Obstet. 2009;105:46–9
11. Walton GD, Ross LE, Stewart DE et al. Decisional conflict among women considering antidepressant medication use in pregnancy. Arch Womens Ment Health. 2014;17:493–501
12. Serati M, Carnevali G. Perinatal depression. In: Altamura AC, Brambilla P, editors. Clinical cases in psychiatry: integrating translational neuroscience approaches. Cham: Springer International Publishing; 2019. p. 155–70
13. Cheung SG, Goldenthal AR, Uhlemann AC et al. Systematic review of gut microbiota and major depression. Front Psychiatry. 2019;10:34
14. Dalile B, Van Oudenhove L, Vervliet B et al. The role of short-chain fatty acids in microbiota-gut-brain communication. Nat Rev Gastroen- terol Hepatol. 2019;16:461–78
15. Peñalver Bernabé B, Maki PM, Dowty SM et al. Precision medicine in perinatal depression in light of the human microbiome. Psychopharmacology. 2020;237:915–41
16. Bellavance MA, Rivest S. The HPA - immune axis and the immunomodulatory actions of glucocorticoids in the brain. Front Immunol. 2014;5:136
17. Suda K, Matsuda K. How Microbes Affect Depression: Underlying Mechanisms via the Gut-Brain Axis and the Modulating Role of Probiotics. Int J Mol Sci. 2022;23:1172
18. Cheung SG, Goldenthal AR, Uhlemann AC et al. Systematic Review of Gut Microbiota and Major Depression. Front Psychiatry. 2019;10:34
19. Zhou Y, Chen C, Yu H et al. Fecal Microbiota Changes in Patients With Postpartum Depressive Disorder. Front Cell Infect Microbiol. 2020;10;567268
20. Zheng P, Zeng B, Zhou C et al. (2016). Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism. Mol. Psychiatry 2016;21:786–796
21. Sudo, N, Chida, Y, Aiba, Y et al. Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. J. Physiol. 2004, 558, 263–275
22. Foster, J. A., and McVey Neufeld, K. A. Gut-brain axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013;36:305–312
23. Bercik P, Verdu EF, Foster JA et al. Chronic gastrointestinal inflammation induces anxiety-like behavior and alters central nervous system biochemistry in mice. Gastroenterology. 2010;139:2102-2112.e1
24. Zheng P, Wu J, Zhang H et al. The gut microbiome modulates gut-brain axis glycerophospholipid metabolism in a region-specific manner in a nonhuman primate model of depression. Mol Psychiatry. 2021;26:2380–92
25. Peñalver Bernabé B, Maki PM, Dowty SM et al. Precision medicine in perinatal depression in light of the human microbiome. Psychopharmacology. 2020;237:915–41
26. Simpson CA, Diaz-Arteche C, Eliby D et al. The gut microbiota in anxiety and depression - a systematic review. Clin Psychol Rev. 2021;83:101943
27. Koren O, Goodrich JK, Cullender TC et al. Host remodeling of the gut microbiome and meta- bolic changes during pregnancy. Cell. 2012;150:470–80
28. Slykerman RF, Hood F, Wickens K et al. Probiotic in Pregnancy Study Group. Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial. EBioMedicine. 2017;24:159-165
29. Park AJ, Collins J, Blennerhassett PA et al. Altered colonic function and microbiota profile in a mouse model of chronic depression. Neurogastroenterol Motil. 2013;25:733-e575.
30. Yu M, Jia H, Zhou C et al. Variations in gut microbiota and fecal metabolic phenotype associated with depres- sion by 16S rRNA gene sequencing and LC/MS-based metabolomics. J Pharm Biomed Anal. 2017;138:231–9.
31. Gu F, Wu Y, Liu Y et al. Lactobacillus casei improves depression-like behavior in chronic unpredictable mild stress-induced rats by the BDNF-TrkB signal pathway and the intestinal microbiota. Food Funct. 2020;11:6148–6157
32. Huang P, Gao T, Dong Z et al. Neural circuitry among connecting the hippocampus, prefrontal cortex and basolateral amygdala in a mouse depression model: Associations correlations between BDNF levels and BOLD—fMRI signals. Brain Res. Bull. 2018;142:107–115
33. Satomura E, Baba H, Nakano Y. et al. Correlations between brain-derived neurotrophic factor and clinical symptoms in medicated patients with major depression. J. Affect. Disord. 2011;135:332–335
34. Dinan T.G, Stanton C, Cryan J.F. Psychobiotics: A novel class of psychotropic. Biol. Psychiatry 2013;74:720–726
35. Schiepers OJ, Wichers MC, Maes M. Cytokines and major depression. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29:201–17
36. Bloch M, Schmidt PJ, Danaceau M et al. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000;157:924–30
37. Mastorakos G, Ilias I. Maternal and fetal hypothalamic-pituitary- adrenal axes during pregnancy and postpartum. Ann N Y Acad Sci. 2003;997:136–49
38. Workman JL, Barha CK, Galea LA. Endocrine substrates of cognitive and affective changes during pregnancy and postpartum. Behav Neurosci. 2012;126:54–72
39. Besedovsky H.O., del Rey A., Klusman I. et al. Cytokines as modulators of the hypothalamus-pituitary-adrenal axis. J. Steroid Biochem. Mol. Biol. 1991;40:613–618
40. Wei G.Z., Martin K.A., Xing, P.Y. et al. Tryptophan-metabolizing gut microbes regulate adult neurogenesis via the aryl hydrocarbon receptor. Proc. Natl. Acad. Sci. USA 2021, 118, e2021091118
41. Asano Y, Hiramoto T, Nishino R et al. Critical role of gut microbiota in the production of biologically active, free catecholamines in the gut lumen of mice. Am. J. Physiol. Gastrointest. Liver Physiol. 2012;303:1288-1295
42. Lee J, Duan W, Mattson M P et al. Evidence that brain-derived neurotrophic factor is required for basal neurogenesis and mediates, in part, the enhancement of neurogenesis by dietary restriction in the hippocampus of adult mice. J. Neurochem. 2002, 82, 1367–1375
43. Knudsen J K, Bundgaard-Nielsen C, Hjerrild S et al.Gut microbiota variations in patients diagnosed with major depressive disorder-A systematic review. Brain Behav. 2021, 11, e02177
44. Mohammadi A.A., Jazayeri S., Khosravi-Darani K. et al. The effects of probiotics on mental health and hypothalamic-pituitary-adrenal axis: A randomized, double-blind, placebo-controlled trial in petrochemical workers. Nutr. Neurosci. 2016;19:387–395
45. Pinto-Sanchez M.I., Hall G.B., Ghajar K. et al. Probiotic Bifidobacterium longum NCC3001 reduces depression scores and alters brain activity: A pilot study in patients with irritable bowel syndrome. Gastroenterology. 2017;153:448–459
46. Benton D , Williams C , Brown A. Impact of consuming a milk drink containing a probiotic on mood and cognition. Eur. J. Clin. Nutr. 2007;61:355–361
47. Nishida K, Sawada D, Kuwano Y et al. Daily administration of paraprobiotic Lactobacillus gasseri CP2305 ameliorates chronic stress-associated symptoms in Japanese medical students. J. Funct. Foods. 2017;36:112–121
48. Nuriel-Ohayon M, Neuman H, Koren O. Microbial changes during pregnancy, birth, and infancy. Front Microbiol. 2016;7:1031
49. Malka O, Kalson D, Yaniv K et al. Cross-kingdom inhibition of bacterial virulence and communication by probiotic yeast metabolites. Microbiome. 2021;9:70
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Irmina Czerepak, Marcin Kapij, Hubert Bochenek, Michał Bzoma, Julia Gugulska, Anna Bielicka, Tomasz Szwarc, Piotr Komasara, Karolina Niewczas, Adrianna Brzozowska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 124
Number of citations: 0
