Back in 2004, when the Johns Hopkins Women’s Mood Disorders Center opened, its goal was to help women grappling with unstable moods at all stages of life. That goal hasn’t changed, but the need for such services grows ever stronger. The center has tripled its volume of visits from women who are pregnant, postpartum, or facing a menstrual cycle-related mood or anxiety disorder. And its staff handles approximately 250 new consultations a year—up from about 75 a year when the program began.
Now center staff members are in the midst of launching programs to accommodate even more women, says Lauren Osborne, its assistant director. Licensed clinical psychologist Tamar Mendelson, a researcher in the Johns Hopkins Bloomberg School of Public Health, has joined the practice a half day a week, working with social worker Samantha Meilmanto provide individual cognitive behavioral therapy to pregnant or postpartum patients and lead a six-week group cognitive behavioral therapy program for new mothers.
In addition, the center started a two-year fellowship program in reproductive psychiatry. Katherine McEvoy, a former chief resident in the psychiatry department, became its first fellow on July 1. In addition to working in the Women’s Mood Disorders Center and Harriet Lane Maternal Mental Health Clinic, McEvoy will spend time with two new services to be located within obstetrics clinics: a resident clinic in the Johns Hopkins Outpatient Center and a maternal-fetal medicine clinic in The Johns Hopkins Hospital.
Many obstetric providers, says Osborne, are not that comfortable treating even low-level depression and anxiety in pregnancy—or if they are, they don’t know what doses of medications to give. “Dr. McEvoy will be there as a resource to those who want to manage patients themselves or to treat patients with more complex needs,” she says.
“With other problems, you may be able to wait a couple of months to see a doctor,”adds Osborne. “But pregnancy has its own issues, and these women need to be seen before they deliver. We think these clinics will allow us to get these patients in faster by being right on-site.”
TAMING POSTPARTUM DEPRESSION
In research news, Jennifer Payne
and Lauren Osborne
, Women’s Mood Disorder Center director and assistant director, respectively, have found that measuring levels of the hormone allopregnanolone during pregnancy could help predict the risk of developing postpartum depression. Allopregnanolone, measured in nanograms per milliliter, is a metabolite of progesterone. Known for its calming effects, it hits the same brain receptors targeted by benzodiazepines and alcohol. In a study of 62 women diagnosed with mood disorders and followed through pregnancy and the postpartum period, the researchers found that every additional nanogram per milliliter of allopregnanolone measured during the second trimester resulted in a 63 percent reduction in the risk of developing postpartum depression.
Furthermore, the change in allopregnanolone from the second to third trimester was associated with DNA methylation levels of a biomarker in the HP1BP3 gene, previously identified by Payne and epigenetic researcher Zachary Kaminsky
to predict postpartum depression. Additional work found that higher levels of the inflammatory cytokine GM-CSF correlated with depression in the third trimester. Osborne and Payne are now looking to replicate the findings in a new cohort of women going forward.
Kaminsky was recently awarded a Maryland Innovation Initiative grant by Tedco for the development of a commercial blood test to identify biomarkers in the HP1BP3 and TTC9B genes that can predict postpartum depression. First up, says Kaminsky, is replicating his and Payne’s research results in a larger patient cohort, with the idea of turning it into a commercial business.