A: It is very common for a new mother to have sudden mood swings after having a baby. She can be anxious, impatient, irritable, or sad, and then happy. This usually occurs 2 to 3 days after childbirth, and goes away within about 2 weeks after delivery. But the "baby blues," as they are often called do not require treatment.

A: The type of treatment used in PPD depends on the severity of the condition. Counseling may be all that is needed for women with mild symptoms. For more severe symptoms, PPD can be treated with medication (antidepressants) and psychotherapy. If a woman is breastfeeding, she needs to talk with her healthcare provider about taking antidepressants. While some antidepressants can affect breast milk, a number of antidepressants can safely be used by mothers who choose to continue nursing. Women with PPD are often advised to attend a support group to talk about their feelings and symptoms. A PPD support group is different from a "new moms group" in that the PPD group allows a new mother to express her fears and guilt with other mothers who understand her situation.

A: Postpartum depression (PPD) is different from the baby blues. Although the symptoms are similar, they are more intense and are present for more than 2 weeks. Symptoms of PPD usually begin 2 to 3 weeks after childbirth, and can last for many months and may become chronic, especially if untreated.

A: It can be difficult to accept an illness and the need for medication to treat it. But medications can be very helpful in treating PPD. Women get better more quickly when they use medication combined with therapy, education, and support. A qualified doctor (usually a psychiatrist or in some states a clinical nurse specialist) knows which medication would be best for an individual patient.

A: Postpartum psychosis is a serious mental disorder. It occurs within the first few days to 4 weeks of delivery. Symptoms are severe and require immediate medical attention, including medication and/or hospitalization. The new mother with postpartum psychosis is severely impaired, and may have paranoia, hallucinations, and delusions. In this state, the mother can be a danger to herself and the child.

A: Generally, treatment for postpartum depression must be continued for 9 months to 1 year after a new mother has fully recovered from her symptoms. Stopping antidepressants too early can make the symptoms return. When medications are to be discontinued, it should be done with medical supervision, with the medication decreased gradually over weeks or months.

A: Postpartum depression is treatable, but it is important to know the signs and symptoms, which include:

• Loss of interest or pleasure in life
• Loss of appetite
• Less energy and motivation to do things
• Difficulty falling asleep or staying asleep
• Sleeping more than usual
• Increased crying or tearfulness
• Feeling worthless, hopeless, or overly guilty
• Feeling restless, irritable, or anxious
• Unexplained weight loss or gain
• Feeling like life isn't worth living
• Having thoughts about hurting yourself
• Worrying about hurting your baby

A: Some antidepressants show up in breast milk in lower amounts than others. It is important to discuss all options with your doctor before starting antidepressant therapy.

A: Depression can be caused by biological, psychological, and/or social problems. Although exact causes of postpartum depression are unknown, researchers believe that the dramatic changes in hormone levels during and after pregnancy may play a role. During pregnancy, the amount of the female hormones estrogen and progesterone increase greatly. Within the first 24 hours after childbirth, these hormone levels drop rapidly, and keep dropping until they reach prepregnancy levels. These extreme changes in hormones may lead to depression.

A: While many women prefer to breast feed their infants, studies have shown that infants develop perfectly well with bottle-feeding. If a mother is depressed and chooses to take an antidepressant to get better, it is actually better for the infant's health and well being. Many studies have shown that babies with depressed mothers develop psychological and behavioral problems compared with babies of non-depressed mothers. From the infant's perspective, it is better to be bottle-fed by a non-depressed mother than breastfed by a depressed mother.

A: For many women, postpartum depression symptoms start during pregnancy. For some women, the symptoms continue for weeks and months after delivery, while for others it disappears after birth.

A: The decision to not take medication to treat PPD is a difficult one, and must be made with strict supervision by your doctor. For severe cases of PPD, it is highly recommended that mothers treat their depression with medication in combination with other therapies. For less severe cases, other therapies may help reduce symptoms. Psychotherapy and "bright light" therapy, for example, have been shown to reduce symptoms. If the decision to not take medication is due to concerns about breastfeeding, remember that some medications are safer than others, and bottle-feeding is also a positive option.

A: Postpartum depression is more likely if a woman has had any of the following:

• A personal or family history of depression or mental illness
• Previous postpartum depression
• Severe premenstrual syndrome
• A difficult marriage
• Few family members or friends to talk to or depend on
• Stressful life events during pregnancy or after childbirth

A: It is not uncommon for mothers with postpartum depression to ask about birth control pills, because understandably, they are afraid of becoming pregnant. However, side effects of birth control pills may include depression. Women who are being treated for PPD should try other forms of birth control, to avoid making their depression worse.

A: Some women who have experienced postpartum depression feel better within a few weeks, but others continue to feel depressed or "not themselves" for many months. Women who have had more severe symptoms, or have a history of depression may take longer to get well. Treatment is very important. Left untreated, postpartum depression can last up to 2 years; some depressed women will not recover, and will continue with chronic symptoms. With proper treatment, most women will achieve results in 2 to 4 weeks, and feel fully recovered in 6 to 8 weeks from of the start of treatment.

A: You can develop a postpartum plan that includes regular screening, taking care of yourself, avoiding exhaustion, asking for help from family and friends, and finding a therapist and support group before delivery.

A: Yes. There are a variety of screening questionnaires that doctors use to determine if a woman is experiencing or at risk for PPD. The most widely used are the Edinburgh Postnatal Depression Scale (EPDS), and the Beck Depression Inventory (BDI). Your obstetrician as well as your pediatrician should be aware of these tools. You can also get a copy of the questionnaire yourself to complete, and bring the results to your doctor. The screening tools are brief and easy to use, and when filled out honestly can help you and your doctor determine the best approach for you.

A: Postpartum depression should be seen as a complication of pregnancy, but having a complication such as PPD does not mean that pregnancy should be avoided. It does mean, however, that a woman is at higher risk of depression, not only after childbirth, but also during pregnancy. To avoid or minimize PPD, women considering second and subsequent pregnancies should speak with their doctors about prevention and/or treatment options of depression.

A: It is not uncommon for mothers who are experiencing postpartum depression to feel guilt and shame, which fuels insecurities about being a good mother. PPD is a medical illness like any other. It is not anyone's fault, and does not mean that a woman is a bad mother.

A: Postpartum depression affects the entire family. All members of the immediate family can help by recognizing and accepting the illness, and agreeing to help however they can. Denying the seriousness of the illness within the family can make it harder for a new mother to recover from PPD. Following are some things that partners and family members can do to help:

• Encourage you to rest as much as possible
• Take you seriously and listen to your concerns
• Go to the doctor or therapist with you to get more information and support for themselves
• Help you set limits
• Sit with you when you're feeling bad
• Tell you that you are loved, and remind you that you won't always feel this way
• Reassure you that they are not going anywhere, and they can wait this out as long as it takes
• Give you permission to do what you need to do to take care of yourself during this vulnerable time
• Continue to take care of each other so they can remain strong and supportive