Post covid hypothalamic- pituitary-adrenal axis dysfunction manifesting as perinatal depression: A case series

Since 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV2) has led to major impact on both the physical as well as mental health. Although the health care facilities aim to provide treatment for the respiratory, cardiovascular as well as neurological manifestations, its huge impact on the mental wellness of patients is somewhat neglected. Perinatal depression is a commonly encountered psychological disorder. Various factors can aggravate or trigger post-partum depression. COVID-19 is one of such triggers. There is microglial cell activation leading to neuroinflammation along with Hypothalmo-pituitary Axis Dysfunction in COVID-19 leading to neuropsychiatric manifestations. Also similarity in genes for Angiotensin Convertase Enzyme 2 and Dopa Decarboxylase leads to reduction in Dopamine and Serotonin in COVID-19 patients leading to Depression. While complications like HELLP Syndrome and Intra Uterine Death remain well reported in association with COVID-19, Post-Partum Depression remains an underreported post COVID sequalae. Thus, we report a case series of COVID-19 positive pregnant patients who suffered from postpartum depression later as a Post COVID sequalae and were successfully treated with antidepressants and cognitive behavioral therapy preventing any complications.