By their bald statement that 'there is little evidence to support a biological basis to postpartum depression' Professors Cooper and Murray as psychologists risk the accusation of taking just as partisan an approach to the subject as can biological psychiatrists.
As we are a species of supremely socialised primates who have evolved awareness of our inner drives and thoughts, all human behaviour and illness,including mental illness, shares biological, psychological and social factors that are so tightly overlapped and interwoven that to divide them in order to exclude some becomes futile. Would Professors Cooper and Murray say, for instance, that there was no biological basis to the attachment behaviour of Harlow's rhesus monkeys or that there was no biology at the root of Bowlby's observations of human infant attachment?
Of course childbirth and early parenthood are profound psychosocial stressors and these aspects must be prominant in any aetiological formulation of postpartum depression. But to see it as only arising from these aspects would run counter to the impression of many psychiatrists that postpartum depression, rather than being a discrete homogeneous disorder, lies along the middle of a spectrum of severity culminating in postpartum psychosis which clearly includes a biological factor in its aetiology.
The biopsychosocial approach to treatment of postpartum depression should use any therapeutic tool available including pharmacological and other biological treatments precisely because all current treatments are inadequate. While the article states that drug treatment is no better, and perhaps less welcome, than psychological treatment the fact that it is effective at all should be promoted rather than minimised. The alternative in clinical practice in many areas is a wait of several months for anything more than the most basic psychological treatments.
That said, the clear detrimental effect of maternal depression on infant development was admirably well put in the article and deserves the widest possible readership. This knowledge should spur us to our best multidisciplinary efforts for the many women and children who suffer from the adverse mental and physical consequences of childbirth.
Rapid Response:
Don't exclude biology.
By their bald statement that 'there is little evidence to support a biological basis to postpartum depression' Professors Cooper and Murray as psychologists risk the accusation of taking just as partisan an approach to the subject as can biological psychiatrists.
As we are a species of supremely socialised primates who have evolved awareness of our inner drives and thoughts, all human behaviour and illness,including mental illness, shares biological, psychological and social factors that are so tightly overlapped and interwoven that to divide them in order to exclude some becomes futile. Would Professors Cooper and Murray say, for instance, that there was no biological basis to the attachment behaviour of Harlow's rhesus monkeys or that there was no biology at the root of Bowlby's observations of human infant attachment?
Of course childbirth and early parenthood are profound psychosocial stressors and these aspects must be prominant in any aetiological formulation of postpartum depression. But to see it as only arising from these aspects would run counter to the impression of many psychiatrists that postpartum depression, rather than being a discrete homogeneous disorder, lies along the middle of a spectrum of severity culminating in postpartum psychosis which clearly includes a biological factor in its aetiology.
The biopsychosocial approach to treatment of postpartum depression should use any therapeutic tool available including pharmacological and other biological treatments precisely because all current treatments are inadequate. While the article states that drug treatment is no better, and perhaps less welcome, than psychological treatment the fact that it is effective at all should be promoted rather than minimised. The alternative in clinical practice in many areas is a wait of several months for anything more than the most basic psychological treatments.
That said, the clear detrimental effect of maternal depression on infant development was admirably well put in the article and deserves the widest possible readership. This knowledge should spur us to our best multidisciplinary efforts for the many women and children who suffer from the adverse mental and physical consequences of childbirth.
Competing interests: No competing interests