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The birth of a baby is an exciting time. But it also is a time of great changes, both emotionally and physically. The sudden responsibility of caring for a newborn, the sleepless nights, and the changing hormones are all part of the transition that goes along with being a new mom. I can remember giving birth to my first daughter and being happy one moment and in unexplained tears the next.

It is estimated that as many as 80 per cent of all mothers will have postpartum blues, commonly called the baby blues. Its onset is within the first month after childbirth. Typically the feelings of being sad and upset, tearful, overwhelmed and exhausted are normal. These feelings usually will pass in a few days. However, for some women, these feelings do not disappear over the following weeks. It is estimated that anywhere from 3 per cent to as many as 20 per cent of births are associated with postpartum depression.

Symptoms of postpartum blues are similar to those of depression that occur at other times. These symptoms include excessive fatigue, sad mood, changes in appetite, inability to concentrate, changes in sleep patterns [even when there is someone there to take care of the baby], tearfulness and irritability. There is lack of interest in pleasurable activities and often feelings of guilt and worthlessness. While these symptoms can be seen in depression in general, postpartum depression also has features of lack of interest in the baby, excess anxiety about the baby's health and thoughts of harming oneself or the baby.

The onset of postpartum depression can be gradual. Many women are fearful of talking about their feelings. As a result, diagnosis and treatment are often delayed.

One of the most severe forms of postpartum mood disorders is postpartum psychosis. This is much rarer than postpartum depression and is thought to affect one or two out of every 1,000 postpartum women. The onset is usually within a few days of delivering, but can occur later as well. The symptoms include confusion, disorientation and hallucinations that might encourage the mother to take her life or that of her child.

In postpartum mania, also a rare disorder, symptoms include an exaggerated sense of well being. Irritability, agitation, reduced sleep and what are often called grandiose thoughts about the importance of themselves or the baby might appear [such as believing the baby is the son of the Queen].

It is not clear what causes postpartum mood disorders. According to the Mood Disorders Society of Canada, some studies suggest that changes in hormone levels following delivery could have a significant effect on a woman's mood.

Risk factors for developing these disorders include any history of depression or bipolar disorders, depression during the pregnancy itself, family history of mood disorders, premenstrual mood disorders, social isolation and poor support systems. Stressful life events might be a risk factor as well.

Postpartum depression also carries with it a risk of relapse. It is estimated that as many as 80 per cent of women with a prior episode might relapse into depression over the next five years. Half of those will have that relapse when they have another child.

Studies also show that doctors, while aware of PPD, do not screen adequately for this illness. A recent study in this month's issue of Pediatrics shows that two simple questions asked of mothers during routine infant-care visits could help identify mothers at risk.

Those questions include: "Lately, do you feel down, depressed or hopeless?" and "During the past month, have you felt very little interest or pleasure in the things you used to enjoy?"

For women who answered yes to both questions, as many as 20 per cent of mothers later went on to develop mild to moderate depression.

It is important to remember that while being a new mother focuses most of your energy on your newborn, it is critical to take care of yourself and take time for yourself -- two tasks that can be difficult to achieve during this period of transition.

Once diagnosed, treatment strategies include psychotherapy, support and medication. Family members need to be supportive, helpful and learn about the disorder. As always, if you feel you are at risk, make sure to see your doctor.

Dr. Marla Shapiro can be seen Tuesdays on CTV's Canada AM. Please direct queries about personal health issues to your doctor.