Written by WCRI adjunct scientist Lori Ross.

Mood changes that occur during the postpartum period can generally be classified into three categories (Ross et al. 2005):

1. The baby blues are a common experience amongst new mothers in the first days postpartum. They can include transient feelings of being overly happy/sad and bouts of unexplainable crying. The 'baby blues' usually resolve within two weeks and require no formal treatment.
2. At the other end of the spectrum is postpartum psychosis. This affects only about 1 in every 500-1000 new mothers. Postpartum psychosis is extremely serious and always requires immediate professional intervention. The hallmark symptoms include disorganized thinking, bizarre behaviour, confusion, self-neglect, delusions, hallucinations or illogical/unreasonable thoughts, often about the baby (e.g. the child is possessed by the devil).
3. More severe than the 'blues', and more common than psychosis, is postpartum depression. It affects between 10-15 per cent of women after childbirth. It is one of the most common, and least often diagnosed, complications for new mothers. The term postpartum depression refers to symptoms of depression that occur during the first year postpartum; however, symptoms of depression are also common during pregnancy and seem to share many of the same risk factors and clinical features as symptoms of postpartum depression.

Symptoms

Symptoms of depression during pregnancy and postpartum are essentially the same as symptoms of depression at any other time, although the content of the symptoms often centres around the pregnancy or baby. Symptoms of depression include:

• Depressed mood
• Loss of interest or pleasure in usual activities
• Changes in appetite, body weight, or sleeping patterns
• Feelings of worthless or guilt
• Fatigue or loss of energy
• Diminished ability to think or concentrate
• Recurrent thoughts of death or suicide (American Psychiatric Association, 1994)

In addition to these symptoms, women with postpartum depression have described:

• feelings of being bad mothers or failures at motherhood
• fears of 'going crazy'
• scary thoughts of harming the baby
• intense feelings of worry, anxiety or panic, particularly about the baby's health or babycare activities (Beck, 2002)

Unfortunately, symptoms of depression can be difficult to recognize, and this is particularly true during pregnancy and the postpartum period. Physical changes, which can be associated with depression, such as changes in body weight and difficulty sleeping, are often difficult to tease out from normal changes associated with pregnancy and postpartum (Ross et al. 2003).

Also, because of the extreme fatigue and multiple stresses that come with having a new baby, the first weeks postpartum are a difficult time for many new moms without postpartum depression. This often makes it very difficult for women themselves to identify that they might have depression, rather than simply believing themselves to be "bad mothers" or unable to cope.

Specific tools (e.g. the Edinburgh Postnatal Depression Scale, Cox et al. 1987) have been developed to help health care providers identify women with postpartum depression. As a general rule, if feelings of sadness or anxiety persist for more than two weeks, and particularly if they are accompanied by changes in appetite or sleep, a visit to a health care provider for further assessment and to rule out other common causes of mood changes (e.g. thyroid problems, anaemia) is recommended. Scary thoughts about wanting to die, or bizarre beliefs or behaviours, can be indications of very serious problems and should be treated as a medical emergency.

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