Question: What differentiates postpartum depression from the "baby blues?"

Answer: There often is confusion about postpartum mood disorders, which can be classified by the following three conditions:

The baby blues are very common and affect about 70 percent to 85 percent of new moms. The baby blues, also known as postpartum blues, usually start within three days of giving birth and can last up to 14 days. They typically go away on their own without treatment and rarely require more than a few days of rest and support.

Postpartum depression (PPD) is more intense and must be present for more than two weeks to distinguish it from the "baby blues." About 10 percent of new mothers suffer from PPD in the first year after giving birth. It can occur after any birth, beginning any time after a woman delivers, but usually begins two to three weeks after giving birth. PPD can last for months — up to a year and a half, or longer, if untreated. PPD often requires counseling and treatment.

Postpartum psychosis (PPP) affects only about one in 1,000 women and most often occurs during the first four weeks after delivery. Patients with PPP are severely impaired and may have paranoia, mood shifts, or hallucinations and delusions that frequently focus on the infant's dying or being demonic. These hallucinations often command the patient to hurt herself or others. This condition requires immediate medical attention and, usually, hospitalization.

Question: Are there predisposing factors that increase a woman's risk of having PPD?

Answer: A personal or family history of depression or mental illness puts one at higher risk for PPD. Other factors that seem to play a role are an unwanted pregnancy; a complicated or difficult labor; a fetal anomaly; a lack of social support; and a temporary upheaval, such as a recent move, death of a loved one, or job change. Women who have previously suffered from depression following the birth of a child have an increased risk of becoming depressed following a subsequent delivery. In women with a history of PPD, the risk of recurrence is about one in three to one in four.

Question: What causes PPD?

Answer: While the causes are not known, research suggests that PPD may be triggered by the hormonal shifts that occur after delivery and are greatly exacerbated by the stress of a major life change.

Question: Are there obvious warning signs of PPD?

Answer: Yes. Symptoms include deep sadness, irritability, apathy, intense anxiety, lack of appetite, inability to sleep, crying spells, irrational behavior, and highly impaired concentration and decision-making. Women with PPD have feelings of being overwhelmed, are unable to cope with daily tasks, and feel guilty about not being a good enough mother.

Question: What is the most appropriate treatment for PPD?

Answer: PPD can be successfully treated with medications, therapy or a combination of both. Counseling may be all that is needed for women with mild symptoms. Special consideration must be given to breast-feeding women, but a number of antidepressants can safely be used by mothers who choose to continue nursing.

Question: Is there a common thread among PPD sufferers?

Answer: PPD does not appear to relate to the mother's age or number of children, nor has it been associated with socioeconomic class or education level. However, feelings of isolation are very common among women with PPD. In most cases, a major factor in PPD is the lack of ongoing support from partners, family members, doctors and friends. Having a good, reliable network to depend on and to help provide care for the newborn is not only comforting but helps the well-being of new mothers.

Question: What role can physicians play in recognizing postpartum depression?

Answer: A strategy for physicians in diagnosing and treating PPD is to identify women at risk during pregnancy and immediately following delivery. Patients identified as having suffered prior episodes of depression, having poor support, or who have other risks for PPD need careful postpartum follow-up. Most often, new mothers are embarrassed about feeling unhappy during a time when society expects them to be elated. One of the best ways for physicians to recognize the symptoms of depression early on is to simply ask their patients specifically about their mood and adjustment to motherhood. Physicians may find it useful to use a simple depression screening scale, such as the Edinburgh Postnatal Depression Scale, to identify patients suspected of having significant depression.

Question: Is anything currently being done to improve access to treatment and support services for women with PPD?