DEAR DOCTOR K:

I had my first baby about a month ago, and ever since I have been feeling depressed and overwhelmed. I keep waiting for these feelings to go away, chalking them up to my adjustment to new parenthood, but they haven't yet. At what point should I seek treatment?

DEAR READER:

Most mothers experience the "baby blues" during the first few days after giving birth. Symptoms include anxiety, irritability and weepiness. They typically worsen by the fourth or fifth day after delivery. Then they go away over the next two weeks. The cause is unknown. It may be simply exhaustion from labor and delivery.

Postpartum depression is different. Compared to the "baby blues," it is more severe, is constant throughout the day and also lasts longer. Since you've been feeling depressed for at least a month, I suspect you have postpartum depression. This condition can make you feel sad, worthless or guilty. You may find you're unable to concentrate or take interest in anything, even your new baby.

We don't know the causes of postpartum depression. Hormone fluctuations are one possibility. During pregnancy, your levels of estrogen and progesterone both rise dramatically. After delivery, those hormone levels plummet. These changes may lead to changes in your mood, sleep patterns, appetite and more.

It's also possible that some women find the prospect of caring for a new baby very stressful. You might predict that this would be more likely to happen in women having their first baby. In fact, postpartum depression does appear to be more common after the first baby than after subsequent births.

One thing that has struck me about my patients with postpartum depression is how guilty they feel. Here they are at what is supposed to be one of the happiest times in their lives, and instead they are sad -- and guilty about being sad.

Postpartum depression occurs in about five women out of every 100 who have a baby. It usually starts in the first two to three weeks after the birth of the baby. If you have had depression in the past, you may be more likely to suffer postpartum depression.

Postpartum depression is not just a problem for women. Some fathers develop depression during the postpartum period, often when their wives develop depression. But fathers can develop depression in the weeks following the birth of the baby even if the mother is not depressed. In fact, some research indicates postpartum depression is more common in men than women.

If you think you have postpartum depression, be sure to seek help. Lack of treatment can take a toll not only on your mental health, but also on the way your baby develops. Fortunately, there are many types of treatment for you to consider, ranging from psychotherapy to antidepressant drugs. Some of these can be taken safely even while a woman is breast-feeding. In severe cases, electro-convulsive therapy can work faster than drugs.

The stresses of motherhood may never fully go away, but your feelings of depression can and should be treated. (Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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