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New moms are supposed to be joyful. But, maybe, instead, you’re feeling weepy, empty and you’re not enjoying your baby or anything else.

Many new mothers sometimes feel moody and overwhelmed at first, even if they are enjoying their baby.  It’s called the “baby blues,” and it doesn’t last more than a couple of weeks. It happens to more than half of women who give birth.  

But if you’re having symptoms such as

• Tearfulness, hopelessness, and feeling empty inside
• Loss of pleasure in daily activities.
• Sleep problems, even when your baby is sleeping.
• Feelings of worthlessness or guilt, with no reasonable cause.
• Difficulty concentrating and making decisions.
• Having trouble caring for and bonding with your baby.

and they don’t get better, you may have postpartum depression (PPD). 

“Symptoms are different for different women,” says Tracy Flanagan MD, Director of Women’s Health, Northern California, Kaiser Permanente, “but they don’t come and go as symptoms of “baby blues” do.”   

Postpartum depression, a serious illness, can last for months after childbirth. It also can happen after miscarriage and stillbirth. Symptoms can begin right away or even months later. Ten to 15 percent of women who give birth experience post partum depression, although not all are diagnosed. Without treatment, PPD goes on for an average of 7 months, and can continue for over a year

Some women feel ashamed or guilty about feeling depressed when they are supposed to be happy. But, it’s important to talk to your doctor about these feelings. The earlier you are treated, the more quickly you will recover. 

While screening for PPD is common in Europe, says Katherine Wisner, MD, national legislation that would require screening of new mothers for PPD is pending in the Senate. Regular screening would also help to reduce the stigma of PPD, says Wisner, the Director of Women’s Behavioral HealthCARE program, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center.

In rare cases - 1 or 2 out of every 1000 births - a woman may have a severe form of depression called postpartum psychosis. She may act strangely, see things that aren't there, and be a danger to herself and her baby. This is an emergency - call a doctor immediately or the national suicide hotline, National Hopeline Network, at 1-800-784-2433.

What causes postpartum depression?
A drop in progesterone and estrogen after childbirth from “sky-high levels,” says Wisner, can trigger depression for some women. A woman is at high risk if this hormonal withdrawal is combined with:

• previous depression (including bipolar disorder),
  
• a family history of depression,
  
• a sick or colicky baby.
  
• little support from your partner or others
• extreme stress.

Your doctor might check your thyroid-stimulating hormone (TSH) levels to make sure a thyroid problem isn't contributing to your symptoms.

How is postpartum depression treated?
It’s important to get treatment for depression so you can begin to feel better and enjoy your new baby.

Postpartum depression is treated with counseling and antidepressant medications. Women with milder depression may choose counseling alone, but many women need both. Counseling for both you and your partner is a good idea.

Researchers like Wisner have studied the effects of drugs on breastfeeding mothers. First-choice drugs, she says, are nortriptylene (a tricyclic), and the SSRIs paroxetine (Paxil) and certralene (Zoloft), which are considered relatively safe for use while breast-feeding.

There have been reports of side effects in babies exposed to fluoxetine (Prozac) and citalopram (Celexa).

Breast-feeding is good for your baby's health and your baby's bond with you too. But if you decide to choose between taking medicine and breast-feeding, treat your depression.

It’s important to take care of yourself by getting help; getting out; and getting enough sleep, exercise and healthy food.

If you have postpartum depression
Postpartum depression is a medical condition, not a sign of weakness. Tell those who care about you about your struggle. You, your health professional, and your friends and family can team up to treat your symptoms so you can get better faster.

Where to find help
Depression After Delivery
Postpartum Support International

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Sources
Tracy Flanagan MD, Director of Women’s Health, Northern California, Kaiser Permanente.
Katherine Wisner, MD, Director of Women’s Behavioral HealthCARE program, Western Psychiatric Insitute and Clinic of University of Pittsburgh Medical Center.
© 1995-2007 Healthwise, Incorporated.
U.S. National Library of Medicine/National Institutes of Health
Women’s Health.gov
Kaiser Permanente health care organization