September 6, 2007

Question: My sister recently had a baby, and now she seems to have a bad case of the "baby blues." I went through some of this as well after my last baby, but I'm worried that hers is becoming a more serious depression. How do you tell the difference between a real depression and just a normal period of adjustment?

Answer: In recent years there has been considerable research on this subject, with findings that provide helpful guidelines for knowing when special intervention is in order. A fairly mild, brief period of postpartum blues is actually quite common, occurring in 50 to 75 percent of new mothers. Symptoms include sadness, crying spells, anxiety, irritability and insomnia, usually lasting from a few days to about two weeks. Many women actually experience a real upswing in mood about two days after the baby is born (about the time most new mothers leave the hospital), but the blues often follow soon after that, peaking at about five days and then gradually getting better without treatment.

Less common is a more serious postpartum depression, which occurs in about 10 to 20 percent of women. This pattern of depression includes the same symptoms as the blues, but in a more severe and longer-lasting form. In addition, mothers are often troubled by intense feelings of guilt, worthlessness and helplessness. They may feel a strong urge to run away and they often feel an aversion to the new baby.

When signs of the blues last for more than a couple of weeks -- and whenever the urge to leave the baby is more than a passing thought -- it is important to get professional help. This pattern of depression is very much like other forms of clinical depression in people who are not new parents, so it is important to treat it seriously. And with a new baby in the picture, this is especially important. Those early months are a special time in the development of attachment between mother and baby, and maternal depression can be a major barrier to those good beginnings.

Finally, in a very small percentage of mothers (about one to three in 1,000), postpartum psychosis occurs. This major psychiatric disorder, which often requires hospitalization, is characterized by disorientation, hallucinations, suicidal thoughts or actions and persistent thoughts of harming the baby. When any of those severe symptoms appear, it is critical that family members seek immediate psychiatric help for the mother in order to prevent serious harm to her or the baby.

Depending on how severe and prolonged your sister's symptoms are, she probably falls into the first or second category (blues or depression). If her symptoms have gone on for more than two weeks, you'd be wise to encourage her to talk to her doctor, who may recommend a therapist or support group.

In the meantime, you can be an important source of support to her as well. Share your own experience with the baby blues, do what you can to help your sister get the food and rest she needs, encourage her to stay connected with others, and help her get up and out for fresh air and exercise. Depression, whether postpartum or not, is a condition that feeds itself; it makes you want to do nothing, and doing nothing makes you feel more depressed. But, along with professional help as needed, caring friends and relatives can make a big difference for both mother and child.

Dr. Erickson and her daughter can be heard every Sunday, from 2 - 4 pm, on "Good Enough Moms," on FM107.1 radio in the Twin Cities or via Webcast at www.FM1071.com