What is postnatal depression and how does it differ from the baby blues? Read about its symptoms, causes, the role of family and how therapy can help.
In the first days after you hold your baby in your arms, alongside happiness, excitement and love you may also feel tiredness, anxiety and an unexpected sadness. When everyone around you says "This is the happiest time of your life" while an emptiness grows inside you, not being able to tell anyone how you feel can be even harder to bear. Postnatal depression, also known as postpartum depression and, in Turkish, "lohusa depresyonu", is a condition that can appear in the weeks or months after birth and noticeably affects a mother's mood, energy and daily life. In this article I will try to explain the symptoms of postnatal depression, how it differs from the baby blues, its causes, how family can help and how it is approached in therapy.
What Is Postnatal Depression?
Postnatal depression is a mood problem that begins in the period following birth and lasts for at least two weeks, showing itself through symptoms such as low mood, loss of interest, tiredness, guilt and anxiety. The symptoms can appear right after birth, or sometimes within a few months. In some mothers, depressive symptoms can even begin during pregnancy and continue after birth; for this reason specialists also look at this period as a whole, as the "perinatal period".
This does not mean that a mother does not love her baby, is not a good mother or is not strong enough. This difficulty can arise from a combination of hormonal changes, lack of sleep, a major shift in the pattern of life and psychological factors. When it is approached with the right support, many mothers recover.
Postnatal depression is not seen only in first-time mothers. It can also appear after a second or third birth. In recent years it has also increasingly been discussed that fathers, too, can show depressive symptoms in the postnatal period.
The Difference Between the Baby Blues and Postnatal Depression
In the first days after birth, many mothers experience a temporary emotional fluctuation known as the "baby blues" (in Turkish, "lohusa hüznü"). During this time a mother may cry for no reason, be easily moved, or feel irritable or anxious. The baby blues usually begins within a few days of birth and eases by itself, mostly within two weeks.
The key features that distinguish depression from the baby blues are:
- Duration: Symptoms last longer than two weeks, or get heavier over time instead of lighter.
- Severity: Emotional distress can reach a level that makes it difficult for the mother to look after herself and her baby.
- Scope: It is not just crying and emotional ups and downs; hopelessness, worthlessness, intense guilt and loss of pleasure also accompany it.
In short, the baby blues is a temporary and expected adjustment process; depression is a condition that needs attention and support.
What Are the Symptoms of Postnatal Depression?
This picture can look different in each mother. Common symptoms are:
- Sadness, emptiness or numbness lasting for most of the day,
- Difficulty bonding with the baby or feeling emotionally distant from the baby,
- Intense feelings of guilt and inadequacy such as "I'm not a good mother",
- Being unable to sleep even when the baby sleeps, or conversely a constant wish to sleep,
- Marked changes in appetite,
- Loss of interest in things that used to bring pleasure,
- Withdrawing from family and friends,
- Intense anxiety, restlessness and a feeling of panic,
- Difficulty concentrating and making decisions,
- Intense, recurring worries that something will happen to the baby,
- Hopelessness and pessimism about the future.
In some mothers, intense anxiety rather than depression is at the forefront. Constantly checking whether the baby is breathing, or having unwanted and disturbing thoughts that harm could come to the baby, can also occur in this period. Thoughts like these can create great shame and fear in a mother; yet they are often a symptom of anxiety and become understandable when shared with a specialist.
Experiencing some of these symptoms does not in itself mean a diagnosis. Sleeplessness and tiredness with a newborn are already an ordinary part of this period. What matters is the duration and severity of the symptoms and how much they affect the mother's daily life. In addition, because some medical conditions such as thyroid problems and anaemia can cause similar symptoms, an assessment by your obstetrician or family doctor is important.
What Causes Postnatal Depression?
Postnatal depression does not have a single cause. Usually several factors come together:
- Hormonal changes: With birth there are sudden drops in the levels of some hormones. These changes can affect mood.
- Lack of sleep and physical exhaustion: Night feeds, the physical effects of birth and having no time to rest reduce emotional resilience.
- Previous mental health history: Having had depression or anxiety problems before, having had depressive symptoms in pregnancy or having similar histories in the family can increase the risk.
- A difficult birth experience: Unexpected complications, emergency interventions or a traumatic birth experience can add to the mother's emotional load.
- Lack of support: Not receiving enough support from a partner, family or those around you; being left alone.
- Life stresses: Concurrent sources of stress such as financial difficulties, relationship problems, moving house or losing a job.
- Expectations and identity change: The gap between idealised expectations of motherhood and the real experience can make a person feel inadequate.
The postnatal period and family support in Turkey
In our culture, the postnatal period known as "lohusalık", especially the first forty days, is seen as a special time in which the older members of the family take close interest. Extended family relationships can be an important source of support in this period: having meals cooked, help with housework and the baby being entrusted to someone else briefly so the mother can rest can lighten the mother's load noticeably.
However, this attention can sometimes turn into pressure on the mother. Different and conflicting advice about baby care, comments such as "We raised children too", criticism about breastfeeding and the obligation to keep entertaining visitors can make a mother feel inadequate or exhausted. On the other hand, for mothers living in big cities far from their families, loneliness and lack of support can be an important risk factor.
Imagine a mother living in a big city far from her family who, after her husband's short paternity leave, spends most of her days alone with her baby. Even though she tells her family on the phone "I'm fine", she cries at night, cannot sleep even when the baby sleeps and thinks, "Everyone manages this, why can't I?" What this mother needs is not to blame herself, but to have her feelings understood and to receive concrete support.
Because mothers are expected to be "always happy and grateful" in society, it can be hard to voice the difficulties experienced after birth. Yet being able to talk about these feelings is one of the important steps of recovery.
Economic conditions can also affect the burden of this period. Having to return to work early after maternity leave because of the cost of living, thinking about childminder or nursery costs and trying to get by on a single income can make a mother's physical and emotional recovery harder. For working mothers, the return to work means a separate adjustment period, with the guilt of being separated from the baby and expectations at the workplace. Planning this transition in advance, talking with your partner and family about sharing tasks, and giving yourself time to adjust can make this period easier.
How Can You Support Yourself in the Postnatal Period?
The suggestions below do not replace professional support, but they can help you get through this period more lightly.
Share your feelings
Telling your partner, someone close whom you trust, or other mothers how you feel helps you realise that you are not alone. Many mothers experience similar feelings but find it hard to put them into words.
Don't hesitate to ask for help
Asking for concrete help such as meals, cleaning, shopping or someone else looking after the baby for a short while is not a weakness. Telling the people who want to help you clearly what you want makes things easier for both you and them.
Prioritise rest
Instead of trying to catch up on housework while your baby sleeps, try resting too. If possible, sharing night feeds with your partner can create the chance for a few hours of uninterrupted sleep.
Soften your expectations
There is no such thing as a "perfect mother". The house may not always be tidy, the baby may not always be calm and you may not always be smiling. In this period, being "good enough" is a realistic and healthy goal.
Take your body into account
Birth is also a major physical experience and recovery takes time. Taking care to eat regular meals, drink enough water and take light walks as far as your doctor allows can also have a positive effect on your mood. If physical pain or problems related to birth continue, don't hesitate to talk to your doctor about them.
Make small spaces for yourself
Setting aside time for yourself, even for a few minutes during the day, for example a short walk, a warm shower or listening to music you like, reminds you that your identity is not made up only of the role of "mother".
A few notes for partners and families
Listening to the mother's feelings without belittling them, avoiding statements like "Your baby is healthy, what more do you want?" and taking on concrete responsibilities are very valuable. If you notice a marked change in the mother, it is important to encourage her to seek support without blaming or judging her.
When Should You Seek Professional Support for Postnatal Depression?
If one or more of the following apply, it is important to talk to a mental health professional:
- If symptoms last longer than two weeks or are getting steadily worse,
- If you find it hard to look after yourself or your baby,
- If you feel intense guilt, worthlessness or hopelessness,
- If you think you are having difficulty bonding with the baby,
- If anxiety and unwanted thoughts clearly affect your day.
If you have thoughts of harming yourself or your baby, if you notice that you are hearing voices or seeing things that are not real, or if there are sudden changes in your behaviour together with extreme confusion and sleeplessness, this requires an urgent assessment. In such a situation, call 112 (Turkey's emergency services) without delay or go to the nearest emergency department.
In breastfeeding mothers, decisions about medication require particular care. For this reason, any assessment about medication support must be made by a psychiatrist in cooperation with your obstetrician.
How Is Postnatal Depression Addressed in Therapy?
In this period, psychotherapy offers important support so that a mother can express her feelings in a safe setting and develop ways of coping with the difficulties of this time. Cognitive behavioural therapy is one of the approaches frequently used in this process and supported by research.
In therapy, work is usually done on the following:
- Normalising feelings: Understanding the feelings the mother is experiencing and lightening the burden of guilt.
- Examining negative thoughts: Reviewing thoughts such as "I'm a bad mother" and "I'll never manage this", and developing more balanced perspectives.
- Working with anxiety and unwanted thoughts: Understanding thoughts that harm could come to the baby and developing skills to cope with them.
- Strengthening the support network: Addressing communication, sharing of tasks and boundaries with the partner and family.
- Self-care and daily structure: Putting rest, nutrition and small enjoyable activities back into daily life.
- Adjusting to a maternal identity: Making sense of the changing role and identity, with its losses and gains.
Looking after yourself well is one of the most important parts of looking after your baby well.
You can read how depressive symptoms are worked with individually on the depression and mood page. Where needed, sessions that include your partner can make room to talk about the change in the relationship and the sharing of the load. In this period when leaving the house with a baby is difficult, sessions can also be continued through online therapy. For more information on the general symptoms of depression, you can look at the article on symptoms of depression.
Frequently Asked Questions
How long does postnatal depression last?
This varies from person to person. When it is noticed early and support is received, recovery usually progresses more easily. When it is not addressed, symptoms can last for months; for this reason it is important to get support rather than wait.
Does the mother's depression affect the baby?
A mother's mental health can affect the relationship with the baby and daily care. However, this does not mean the mother is to blame. When the mother receives support, both she and her relationship with her baby are affected positively.
Do fathers get postnatal depression too?
Yes, fathers can also experience depressive symptoms in the postnatal period. Lack of sleep, increased responsibilities, financial worries and changes in the relationship can be hard on fathers as well. In fathers it more often shows up as irritability, withdrawal or burying oneself in work.
Can I have therapy while breastfeeding?
Yes. Psychotherapy is a form of support that does not affect breastfeeding and can be continued safely in this period. Whether medication support is needed is determined separately by a psychiatrist's assessment. If you are struggling in this period, it is important to know that you are not alone and that getting support is possible.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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