In the literature, postpartum mood disorders are described along a continuum with postpartum blues at one end and a rare condition at the other end known as postpartum psychosis. Post partum depression falls somewhere in between the two.

Postpartum depression is a relatively new term, first being described by Winn in the 1960s. There are at least two separate syndromes, with a possible phase that would appear to be a transitional one between the milder condition (postpartum or baby blues) and the more serious condition (postpartum psychosis). This transitional phase is postpartum depression. The three different postpartum mood disorders vary in severity of symptoms, onset and duration of the disorder. The prevalence of postpartum blues varies from 26-80 percent. However, most women experience some fluctuating moods during the first few days postpartum and can last up to two weeks postpartum. This period is known as the "baby blues." These mood changes are so common that they are considered within the normal range of postpartum recovery. The symptoms of the blues include emotional lability, confusion, anxiety, crying, weepiness and sometimes sadness. These symptoms are short lived and usually resolve without professional help. Recent studies suggest that this period can be less stressful with significant help postpartum. Family members and partners who provide rest, nutrition, and emotional support to the new mother can help to shorten or alleviate some of the "baby blues."

Postpartum depression affects approximately 10-20 percent of mothers. PPD can begin anytime in the first postpartum year. Most often it occurs within the first 3 months of delivery. PPD includes a variety of symptoms: insomnia or sleep disturbances, extreme fatigue, irrational fears about baby's health or safety, worrying and severe anxiety, loss of appetite, obsessive thinking, panic or anxiety attacks, sad and depressed mood, lack of pleasure or motivation in usual interests, feelings of being out of control, feelings of inadequacy and low self-esteem, difficulty in daily functioning, inability to cope, and sometimes even suicidal thoughts. Women experiencing these symptoms require professional mental health treatment.

The exact cause of postpartum depression is unknown. Hormonal changes have been looked at and researched extensively. The data is inconclusive. Therefore, did your progesterone withdrawal postpartum cause your depression? We cannot be sure. However it probably had some role in your PPD. You stated your pregnancy was trouble free, so I would not expect you to experience any depression in this pregnancy. Between 5-20 percent of those mothers who experienced PPD with their first pregnancy will experience some degree of depression with subsequent pregnancies.

The good new is you can do something about it. While hormone factors have been implicated in PPD, other life events play a role also. If you worked with a therapist or a mental health provider during your PPD, call her during your pregnancy so you can plan ahead. If lack of physical and emotional help played a role in your PPD then knowing this can help you to set up some help prior to this delivery. If medication was part of your recovery, then have something prescribed prior to your delivery so it is there if and when you need it. Also let your OB/midwife know you experienced PPD and are concerned about the recurrence. This fosters open communication and may result in earlier intervention. The good new is with proper treatment PPD sufferers have a recovery rate of more than 90 percent.

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