The new mother had also given birth to a previously undiagnosed and untreated condition now known as postpartum depression.

Bowyer is in vast company.

For one in five mothers, the arrival of a baby marks a distressing change. Their lives are disrupted by frightening feelings of chronic exhaustion, isolation, tearfulness, despondency, hopelessness, panic, inadequacy, irritability and inability to cope.

Some suffer severe anxiety and can't leave the house. They're so afraid that their baby will be harmed - become ill or injured - that they cling to it. Others are the opposite. They cannot connect with the baby; they have no feelings forit.

Some contemplate suicide; others fantasize about harming the child.

Family members typically can't understand why. Through minimizing or criticizing the symptoms, they frequently compound the problem.

"The depression comes at a time when women are supposed to be the happiest. Culture tells them they should never be depressed right after giving birth to a baby, so women are ashamed and embarrassed for feeling this way," said Heidi Sonntag, a licensed social worker.

Sonntag is director of one of several local support groups initiated to break the silence. Her newly formed group, which meets weekly at LDS Hospital, provides a climate where women can "open up."

"Their feelings are legitimized and normalized; they realize they aren't going crazy, they aren't failures as mothers."

It's typically in these support groups, not in physicians' offices, where sufferers are helped to understand postpartum depression.

It differs from the "baby blues," or the more serious postpartum psychosis. (See chart.)

"Postpartum depression is an overwhelming depression that sort of creeps on to you, and within six to eight weeks you don't know how to escape the insidious depression," Sonntag said. "If left unrecognized and untreated, it can have a lasting impact on the emotional health of the mother as well as serious repercussion to her infant and family."

The depression can occur after any birth, not necessarily only after the first child. Adoptive mothers aren't immune. Women who have miscarriages are also susceptible.

The exact cause of postpartum depression is unknown, and researchers believe there may be more than one cause.

"Because of the rapid hormonal changes that take place during pregnancy and after delivery, researchers believe that there is a strong biological component," Sonntag said. "The pituitary and thyroid are sluggish, hormones are out of balance. There's also a lot of blood and fluid loss, so the body isn't normal forabout a year."

Sonntag said psychological and social factors also can contribute to the depression. Women's high expectations about motherhood are unfulfilled. Many suffer an identify crisis.

"Jan is typical of a postpartum depressed mother because she had a successful career, was independent, achievement orientated," Sonntag said. "Researchersat LDS Hospital believe the reason postpartum depression is on the increase is because more women are waiting longer to have children."

The transition from career woman to mother is thus much harder; the adjustment much more difficult.

"Regardless of the severity of the symptoms, women need to realize these problems are real. They can be treated, they are temporary, she is not crazy, and most of all she is not alone," Sonntag said.

Medications such as antidepressants or tranquilizers can provide temporary relief. They rarely cure the depression.

More vital to the recovery process, Sonntag said, is the woman taking care of herself and receiving support from others.

"A woman suffering from postpartum depression needs the support, understanding and acceptance of her friends, physician and family - especially her husband," Sonntag said.



More than baby blues

- Postpartum blues: Affects 50 to 80 percent of all mothers. Thought to be related to the sudden hormonal drop. Symptoms occur on the third or fourth day after a birth and last from a few hours to a few weeks. Common symptoms are frequent crying for no apparent reason, mood swings, fatigue, exaggerated empathy, irritability, strange lack of feeling for the infant, oversensitivity, elation, confusion, anxiety. - Postpartum depression: Affects 15 to 20 percent of women. Can occur immediately after birth or many months later, and can last several months or years. Symptoms include chronic exhaustion, despondency, inability to cope, anxiety or panic attacks, impaired concentration and memory, bizarre thoughts that might include suicide or harming the infant or other family members, tearfulness, irritability, feelings of helplessness and hopelessness, nightmares. - Postpartum psychosis: Occurs once in about every 1,000 births. Usually has an onset early in the postpartum period, most commonly between the third and 14th day, but can occur later. Symptoms can include suspiciousness, incoherence, excessive concern over trivialities, confusion, irrational statements and refusal o food. Woman may lose touch with reality, experience hallucinations, delirium an mania.