But other factors may also play a role. Stress hormones, which could be activated by the stress of caring for a newborn, might play a role in triggering depression. And the sleep deprivation that new mothers experience might further fan the flames of smoldering depression.
What is unusual about the treatment of postpartum depression is that the impact of the illness and its management on the baby need to be factored into the equation along with the impact on the mother herself, according to Payne, who reviewed the management of postpartum depression in the American Journal of Psychiatry last month.
On the one hand, there is the potential risk of treatment -- exposure of babies to antidepressant medication -- while on the other hand, there are the risks of no treatment, which include the risk of depression to the mother, poor bonding between mother and child, and possible effects on IQ, language and development in a child whose mother is depressed.
Antidepressant treatment during breast-feeding is often the best choice, although the baby will be exposed to the antidepressant in breast milk. In general, studies have not found high rates of problems in babies exposed to antidepressants, although the long-term outcome of this exposure is unknown.
Mothers can minimize their baby's exposure to the highest medication levels by taking the antidepressant immediately after breast-feeding. Mothers should be educated about potential side effects of any medication prescribed during breast-feeding. Involvement of the pediatrician can help in monitoring the baby for problems such as sedation, changes in sleep or feeding, and irritability.
Approaches that do not involve medication, such as the "talk" therapies, especially cognitive behavior therapy and interpersonal psychotherapy, may also be useful in patients with postpartum depression and should be considered part of the treatment plan.
*Name changed for confidentiality
Dr. James Potash is an associate professor of psychiatry and co-director of the Mood Disorders Program (http://www.hopkinsmedicine.org/moods) at the Johns Hopkins School of Medicine in Baltimore. If you have questions or comments, please e-mail at email@example.com. To participate in our studies, call 877-MOODS-JH.