After having a baby, many women have mood swings. One minute they feel happy, the next minute they start to cry. They may feel a little depressed, have a hard time concentrating, lose their appetite or find that they can't sleep well even when the baby is asleep. These symptoms usually start about 2 to 4 days after delivery and may last for several days.

If you are a new mother and have any of these symptoms, or have had them in the past, you are amongst the 70 to 80% of women who get what is called the "baby blues". "The blues" are considered a normal part of early motherhood and usually go away within 10 days of the delivery. However, some women have worse symptoms or symptoms that last longer. This is called postpartum depression. What is postpartum depression?
Instead of this relatively mild sadness and anxiety, about 10% of new mothers develop a more troubling condition called postpartum depression. Postpartum depression lasts longer, is more intense, and often requires counseling and treatment. Postpartum depression can occur after any birth, not just the first. Here are some symptoms of postpartum depression:

• Postpartum blues that don't go away after 2 weeks
• Strong feelings of depression and anger that begin to surface 1 to 2 months after childbirth
• Loss of interest in things that used to bring pleasure in life
• Less energy and motivation to do things
• Marked changes in appetite
• A hard time falling asleep or staying asleep or sleeping more than usual
• Increased crying or tearfulness
• Feelings of sadness, doubt, guilt, helplessness, or hopelessness that seem to increase with each week and begin to disrupt a woman's normal functioning. The woman may not be able to care for herself or her baby. She may have trouble handling her usual responsibilities at home or on the job.
• Feeling restless, irritable or anxious (for example being frightened of being left alone in the house with the baby)
• Unexplained weight loss or gain
• Having thoughts about hurting yourself, including suicide
• Fear of harming the baby. These feelings are almost never acted on by women with postpartum depression, but they can be very frightening and may lead to guilty feelings, which only make the depression worse
• Extreme concern and worry about the baby, or lack of interest in or feelings for the baby. Feeling unable to love the infant or rest of the family.

Although many women get depressed right after childbirth, some women don't feel "down" until several weeks or months later. Depression that occurs within 6 months of childbirth may be postpartum depression.

Who gets postpartum depression?
Postpartum depression is more likely if you had any of the following:

• Previous postpartum depression or another psychiatric condition not related to pregnancy
• Severe premenstrual syndrome (PMS)
• A difficult marriage or lack of supportive partner
• Few family members or friends to talk to or depend on
• Stressful life events during the pregnancy or after the childbirth.

Why do women get postpartum depression?
There are many causes. Hormone levels change during pregnancy and right after childbirth. Those hormone changes may produce chemical changes in the brain that play a part in causing depression.

Low thyroid functioning is very common in women after childbirth. The baby's thyroid can produce antibodies against the mother's thyroid causing hypothyroidism. This may be one of the chief causes of postpartum depression and weight gain.

Long chain polyunsaturated omega 3 fatty acid deficiency may contribute to depressive symptoms in alcoholism, multiple sclerosis and postpartum depression. Adequate long chain polyunsaturated fatty acids, particularly docosahexaenoic acid (DHA), may reduce the incidence of depression just as omega 3 fatty acids may reduce the incidence of coronary heart disease.

In studying 20 healthy primiparous women (women bearing their first child) without significant health or psychiatric problems, a significant connection between reduced serum cholesterol levels and depressive symptoms postpartum was found.

How long does postpartum depression last?
It's hard to say. Some women feel better within a few weeks, but others feel depressed or "not themselves" for many months. Women who have more severe symptoms of depression or who have had depression in the past may take longer to get well. Just remember that help is available and that you can get better.

What kinds of treatments help with postpartum depression?
Postpartum depression is treated much like any other depression. Support, counseling ("talk therapy") and medicines can help. If you take an antidepressant medicine, it will go into your breast milk. Talk to your doctor about the risks of taking an antidepressant while nursing. Your doctor can decide which medicine you can use while nursing your baby.

If you have given birth recently and are feeling sad, blue, anxious, irritable, tired or have any of the other symptoms mentioned here, remember that many other women have had the same experience. You're not "losing your mind" or "going crazy" and you shouldn't feel that you just have to suffer. Here are some things you can do that other mothers with postpartum depression have found helpful:

• Find someone to talk to and tell that person about your feelings.
• Get in touch with people who can help you with child care, household chores and errands. This social support network will help you find time for yourself so you can rest.
• Find time to do something for yourself, even if it's only 15 minutes a day. Try reading, exercising (walking is good for you and easy to do), taking a bath or meditating.
• Keep a diary. Every day, write down your emotions and feelings as a way of "letting it all out." Once you begin to feel better, you can go back and reread your diary. This will help you see how much better you are.
• Even if you can only get one thing done in any given day, this is a step in the right direction. There may be days when you can't get anything done. Try not to get angry with yourself when this happens.
• It's OK to feel overwhelmed. Childbirth brings many changes, and parenting is challenging. When you're not feeling like yourself, these changes can seem like too much to cope with.
• You're not expected to be a "supermom". Be honest about how much you can do, and ask other people to help you.
• Find a support group in your area or contact an organization that can put you in touch with people near you who have experience with postpartum depression.
• Talk with your doctor about how you feel. He or she may offer counseling and/or treatments that can help.

Feeling depressed doesn't mean that you're a bad person, that you did something wrong or that you necessarily brought this on yourself.

References:
(1) "Dietary Polyunsaturated Fatty Acids and Depression: When Cholesterol Does Not Satisfy", Hibbeln, Joseph R. and Salem, Norman, Jr., American Journal of Clinical Nutrition, 1995;62: pp.1-9.
(2) "Rapid Decrease of Serum Cholesterol Concentration and Postpartum Depression," Ploeckinger, Barbara, et al, British Medical Journal, September 14, 1996;313: p.664.