The Difference Between Blue and Black : New mothers: Being a little down is normal and usually cures itself, but deep depression isn’t and requires expert treatment.

Most women get the blues after giving birth, but the difference between that mild feeling of “being down” and an all-out depression is like the difference between a gentle spring rain and a flood, professionals say.

The “baby blues” are usually marked by fatigue and frequently tears, said Dr. Lori Altshuler, a psychiatrist who teaches at UCLA Medical Center and has a private practice in Manhattan Beach.

The blues typically start from three to seven days after birth and last a few weeks, Altshuler said. Expectant mothers are often told that such a feeling is normal, because “it helps them not feel anxious.”

But a woman struck by full-fledged postpartum depression often has insomnia, is agitated and has trouble concentrating, Altshuler said. Other symptoms may include a feeling of worthlessness, decreased appetite and a loss of interest in her surroundings, including the baby.

Where the blues cure themselves, a clinical depression requires medication and counseling.

The psychiatrist said one problem with postpartum depression is that it may not show itself until a week or more--sometimes months--after the baby is born. By that time the mother is home, without professional help. As a result, the first professional to realize what the mother is experiencing may be a pediatrician seeing the baby when the mother brings it in for a checkup.

Altshuler said about one in 10 new mothers develop postpartum depression. About one in 1,000 develop postpartum psychosis, which she defined as losing touch with reality. The psychotic mother may think her baby is deformed when it’s fine, may hear voices or see apparitions.

Even among the minority of women who become psychotic, the risk of a mother killing her child is only about 3%, Altshuler said. “It’s not a huge number, but it is more than insignificant.”

Yet the psychiatrists’ bible, the Diagnostic and Statistical Manual, does not have a separate entry for postpartum psychosis.

The manual lists definite symptoms for its diseases, but in postpartum psychosis, “symptoms are so variable that (the disease) doesn’t fit into one category,” Altshuler said. As a result, the index listing for the illness refers doctors to other forms of mental illness, such as major depression.

Although some doctors say the trauma of giving birth triggers previous mental disorders, others contend it is a separate illness that stems from hormonal changes caused by the birth process.

Altshuler, who trained at the National Institute of Mental Health, said many women fear entering a hospital lest it interrupt their bonding with their child. But she said that one study found there was not much difference between children not separated from their mothers and those separated for a short period “as long as there are some other loving surrogates attending to the child.”

Psychiatrists say that some women suffering from postpartum depression kill themselves apparently so they don’t harm their babies.

In April of 1987, on her 23rd birthday, Sheryl Massip of Anaheim tried to throw her 6-week-old son, Michael, into oncoming traffic, but a car swerved and avoided the baby. Then Massip positioned the infant under the wheel of her Volvo, drove over him and put the body in a trash can.

After a jury convicted her of second-degree murder, Orange County Superior Judge Robert R. Fitzgerald stunned the legal community by reducing the verdict to voluntary manslaughter and also acquitting Massip because of insanity.

The state Supreme Court agreed last month to consider the prosecution’s appeal of Fitzgerald’s ruling.

The Massip trial led psychologist Virginia Watford to start a support group for women suffering postpartum depression. Operated out of Mission Hospital Regional Medical Center in Mission Viejo, the group meets weekly and has included more than 100 women in the two years of its existence, Watford said.