Beyond the Blues

Q: What’s the difference between “baby blues” and postpartum depression?

A: The baby blues are common, affecting up to 85% of new mothers. Frequently described as “bad PMS,” the blues most often strike within days of childbirth and pass in about two weeks. Reassurance, support and education help. Postpartum depression sets in two to four weeks after delivery and, without proper attention, can pose serious risks for mother and baby. It should not be confused with postpartum psychosis, a severe illness that leaves some sufferers at risk for suicide, child abuse or infanticide.

Q: How do the symptoms differ?

A: Baby blues include mood swings, tearfulness, anxiety and irritability. Postpartum depression includes crying, anxiety, obsession, feelings of guilt, changes in sleep and appetite.

Q: How often does postpartum depression occur?

A: Overall, the rate is about 10%, affecting roughly 400,000 of the 4 million American women who give birth each year. For women with no history of depression, the rate is 2% to 5%. For women who have already experienced depression, the rate increases to 25%. For women depressed during the pregnancy, the rate is 33%. For women depressed after a previous pregnancy, the rate is as high as 50%.

Q: How are they treated?

A: Because the baby blues normally pass without long-term consequences, medication and other types of intervention beyond the support of family and friends usually aren’t needed. Postpartum depression can be treated with antidepressants, talk therapy or electroshock. Some psychiatrists and psychologists are getting results with experimental light therapy in which the patient sits in front of light boxes similar to those used to lift “winter blues.”

Q: How long are medications given?

A: Postpartum medications are often begun preventively the day of delivery and occasionally even in the last weeks of pregnancy. More often, they’re prescribed at the time of diagnosis and continued for about a year.

Q: Should a mother on antidepressants breast-feed?

A: Breast milk contains many substances beneficial to a newborn, such as antibodies and growth factors that protect against infections and promote maturation of the digestive tract. For that reason, the American Academy of Pediatrics favors it even for women taking antidepressants. However, many doctors advise women on medication to bottle-feed. For mothers who insist on breast-feeding, doctors often prescribe one of the longer-established antidepressants like nortriptaline, part of the tricyclic family, because they know more about its effects. An Emory University study of Zoloft, one of the new generation of antidepressants, found no adverse effects in the breast-fed infant. The study is being expanded to include Prozac and Paxil, which also belong to the family of selective serotonin reuptake inhibitors. Studies so far indicate that mother’s milk exposes the breast-feeding baby to less than 1% of the antidepressant dose the mother receives.