Postnatal Depression and Its Effect on the Baby

The feeling expected after birth is happiness. That expectation places a second burden on a mother who does not feel well: both low mood and guilt for feeling it.

Postnatal depression is not a weakness of character, a choice, or a lack of "mothering ability". It is a diagnosable and treatable condition arising from the convergence of hormonal, biological and psychosocial factors.

This article helps you distinguish the baby blues from depression, recognise the symptoms, understand the effect on a baby's development, and see when to seek help.

Key Points

• The baby blues occur after most births, last a few days and resolve on their own; they are not depression.
• Postnatal depression lasts more than two weeks, occupies most of the day and impairs functioning.
• Left untreated it affects not only the mother but the baby's emotional and cognitive development.
• Postnatal depression also occurs in fathers; it is frequently missed and presents as anger, withdrawal or throwing oneself into work.
• Recovery rates are high with early diagnosis and treatment; there are treatment options suitable for breastfeeding, and the decision is made with the mother.

Baby Blues or Depression?

This distinction is the critical point, because the two require entirely different approaches.

The Baby Blues

Begins in the first days after birth. Tearfulness, mood swings, anxiety and fatigue are seen. It relates to hormonal change and sleep deprivation.

Its defining feature: it resolves on its own and does not markedly impair the mother's capacity to care for her baby. It requires no treatment; support and rest suffice.

Postnatal Depression

Symptoms last more than two weeks and do not decrease in intensity, or worsen. The mother's daily functioning is impaired; caring for the baby, her own self-care and running the home become difficult.

Onset may be in the first weeks after birth, but it can also emerge months later. There are forms that begin during pregnancy and extend beyond the birth.

Postpartum Psychosis

A rare but emergency presentation requiring immediate intervention. Impaired reality testing, delusions, hallucinations, extreme agitation and disorganised behaviour are seen. It usually begins within the first two weeks after birth.

This picture requires emergency intervention. For the safety of mother and baby, the nearest emergency department should be contacted without delay.

Symptoms

Emotional Symptoms

• Low mood or emptiness on most days
• Inability to take pleasure in things previously enjoyed
• Feeling differently about the baby than expected: distance, indifference or excessive anxiety
• Intense guilt and inadequacy: "I'm a bad mother"
• Irritability, outbursts of anger
• Constant crying, or conversely being unable to cry at all

Physical and Cognitive Symptoms

• Being unable to sleep even when the baby sleeps, or sleeping excessively
• Marked decrease or increase in appetite
• Constant fatigue, absence of energy
• Difficulty concentrating and making decisions
• Unexplained physical pain

Symptoms Requiring Attention

• Fear of harming the baby, or intrusive thoughts of doing so
• Thoughts of self-harm or of dying
• Stopping caring for the baby altogether
• Signs of detachment from reality

Thoughts of harming the baby are the symptom families fear most and voice least. The great majority of these thoughts are intrusive and anxiety-driven; the mother meets them with horror and never wishes to act on them. They must nonetheless be shared and assessed.

Why Does It Happen?

There is no single cause; factors converge.

Biological Factors

The sudden fall in oestrogen and progesterone after birth affects the systems regulating mood. Thyroid dysfunction and iron deficiency can also aggravate the picture; investigations are therefore requested during assessment.

Psychological and Historical Factors

• Previous depression or anxiety disorder (the strongest risk factor)
• Postnatal depression in a previous pregnancy
• Depressive symptoms during pregnancy
• A traumatic birth experience
• A history of neglect or abuse in the mother's own childhood

Social Factors

• Inadequate social support, isolation
• Tension in the relationship with a partner
• Financial difficulty
• The baby's health problems, prematurity, intensive care
• Feeding difficulties, colic, disrupted sleep

Unrealistic Expectations

The expectation of the "perfect mother", flawless accounts of motherhood on social media and talk of "the happiest days" lead a mother to believe what she is experiencing is abnormal. This is the most common factor delaying help-seeking; the mother assumes no one else has felt this and stays silent.

Postnatal Anxiety Disorder

Postnatal anxiety disorder also occurs, with or independently of depression, and is frequently missed.

Its features: constantly checking whether the baby is breathing, being unable to leave the baby with anyone, recurrent thoughts about possible catastrophes, palpitations and chest tightness, being unable to relax even while the baby sleeps.

A degree of apprehension is normal in new parenthood. Assessment is needed when anxiety impairs functioning, when the mother can no longer rest, and when checking occupies most of the day.

Effect on the Baby

This section may worry mothers; but the aim is not to blame, rather to show why treatment matters. Where depression is treated, these effects are largely prevented.

Effect on Attachment

A baby learns about the world through reciprocal interaction with a caregiver: receiving a response when crying, being answered when smiling. In a depressed mother this reciprocity may decrease; responses are delayed or facial expression flattens.

This can make secure attachment harder to establish. But attachment is not confined to a single period; the relationship can be repaired as the mother recovers.

Emotional and Cognitive Development

Long-term untreated maternal depression increases the child's later risk of difficulty with emotion regulation, anxiety and behavioural problems. Delay in language development has also been reported, because the amount of speech directed at the baby decreases.

What is decisive is the duration and severity of the depression. A brief, treated episode does not leave a lasting effect.

Protective Factors

The responsive attention of a father or another caregiver protects the baby considerably. The treatment plan therefore covers not only the mother but the network of caregivers. The baby being in reciprocal, responsive interaction for part of the day forms an important buffer during the mother's recovery.

When Does It Begin?

The onset of postnatal depression is broader than assumed. Symptoms may begin in the first weeks after birth, but can also emerge in the third, sixth or even twelfth month.

There are also forms beginning in pregnancy and extending past the birth; these usually last longer and early recognition matters.

Late-onset presentations are frequently missed because the family thinks "that period has passed". Yet low mood beginning in a baby's sixth month also falls within postnatal depression.

Postnatal Depression in Fathers

A frequently missed presentation. In fathers symptoms often do not look like classic low mood; they appear as anger, irritability, throwing oneself into work, withdrawal from the family, or increased alcohol use.

Depression in the mother also increases the risk in the father. Where both parents are affected the baby's protective resource is reduced, so assessment of the father should not be neglected.

Treatment

Psychotherapy

In Assoc. Prof. Mehtap Eroglu's approach, psychotherapy is first-line for mild to moderate presentations. Cognitive behavioural therapy and interpersonal therapy are approaches with demonstrated effectiveness in postnatal depression.

Interpersonal therapy is particularly suited to this period; it directly addresses matters specific to the postnatal phase such as role transition, the partner relationship and social support.

Medication

Considered in moderate and severe presentations, where symptoms markedly impair functioning.

The question families ask most about breastfeeding is: "If I take medication, can I not breastfeed?" There are options usable during breastfeeding with low transfer into milk. The decision is made together, taking account of the severity of the mother's condition and her preferences.

It is also weighed in that decision that the effect of untreated depression on the baby may be greater than the risk of an appropriately chosen medication.

Breastfeeding and Medication: How Is the Decision Made?

This is where families struggle most, and it is usually perceived as all or nothing.

In reality the decision rests on weighing three things: the severity of the mother's condition, how important breastfeeding is to her, and the milk-transfer profile of the medication chosen. Options with broader data on use during breastfeeding are available.

Stopping breastfeeding is also a legitimate choice and should not become a matter of guilt. A mother whose depression has been treated and who can respond to her baby is more protective for that baby than an exhausted mother who breastfeeds.

Social Support and Sleep

Sleep deprivation is both a trigger and a maintaining factor, and a component of treatment that cannot be ignored. Sharing night care so the mother can obtain an uninterrupted block of sleep is a concrete part of treatment.

Handing over household tasks, limiting visitors, and the mother being able to spend some time each day away from the baby are also supportive.

Mother-Infant Focused Work

Where the attachment relationship is strained, approaches working with mother and baby together are used. The aim is to re-establish reciprocal interaction and increase the mother's confidence in reading her baby's signals.

What Can Those Close to Her Do?

In postnatal depression, the attitude of those around a mother directly determines whether she seeks help.

Helpful Approaches

• Offer concrete help. "Tell me if you need anything" is less useful than "I'm bringing dinner on Tuesday" or "let me take the baby this afternoon while you sleep".
• Do not invalidate the feeling. Phrases like "look, your baby is perfectly healthy, be grateful" increase guilt.
• Make room for sleep. A mother obtaining an uninterrupted block of sleep is part of treatment.
• Limit visitors. Constant guests in the early weeks make rest impossible.
• Normalise seeking help. "This is very common and treatable" is the most effective sentence for reducing shame.

What to Avoid

• "I went through it too, it passes" — encourages waiting and delays referral.
• Criticising mothering ability — deepens an already high sense of inadequacy.
• Taking over the baby completely — excludes the mother from the relationship and increases her insecurity. Supporting is not replacing.
• Comparison — remarks such as "your sister wasn't like this after her birth" isolate.

Future Pregnancies and Prevention

Having had postnatal depression in one pregnancy is among the strongest factors increasing risk in subsequent ones. But that does not mean it will recur; knowing in advance is a protective advantage.

What Can Be Done During Pregnancy

• Sharing the history with the clinician before the birth and setting up a monitoring plan
• Addressing depressive symptoms arising in pregnancy without waiting
• Planning the support network for the first weeks in advance: who, which day, doing what
• Discussing sleep arrangements so that they are shared from the outset

Early Screening

Brief screening scales in the first months after birth are an effective way of catching the picture early. These do not make a diagnosis but identify mothers who need assessment.

In follow-up in Ankara, repeating this screening routinely is recommended, particularly in mothers with a history.

When Should Help Be Sought?

• Symptoms have lasted more than two weeks
• Daily functioning is impaired: caring for the baby or oneself has become difficult
• You feel nothing towards the baby, or there is intense distance
• Guilt and inadequacy cannot be soothed
• Thoughts of harming yourself or the baby arise
• You cannot sleep even when there is an opportunity
• Those around you have noticed the change and are concerned

If one of the symptoms in that list is present, do not wait: thoughts of harm or signs of detachment from reality require emergency referral.

Expert Opinion

According to Assoc. Prof. Mehtap Eroglu, the greatest obstacle in postnatal depression is not diagnosis but the shame standing in the way of seeking help. Mothers often fear being seen as "a bad mother" if they voice what they feel, and stay silent.

Clinical experience from consultations in Ankara shows that naming this feeling is itself a relief. Learning that what one is experiencing is common, recognisable and treatable is the most important step of the process.

Assoc. Prof. Mehtap Eroglu also emphasises the importance of understanding thoughts of harming the baby correctly. The great majority are anxiety-driven intrusive thoughts, and the mother is horrified by them. Voicing them signals not danger but the need for assessment.

A further important point is that treatment is directed not only at the mother but at the system. Sharing the sleep schedule, involving a partner and organising social support can be more decisive than medication alone.

Assessment and Appointment Process in Ankara

Referrals for postnatal depression in Ankara usually come late; mothers arrive having waited months and tried to put things right themselves.

In the assessment conducted by Assoc. Prof. Mehtap Eroglu in Ankara, the process begins with when the symptoms started and how they have progressed. Mental health history before the birth, the birth experience, sleep patterns and social support are each addressed. Investigations may be requested to exclude medical causes such as thyroid dysfunction and iron deficiency.

The second part of the assessment concerns the mother-infant relationship: her feelings about the baby, care routines and the moments she struggles with are discussed. Where possible the partner is invited to attend; in referrals in Ankara, recovery is noticeably faster where the partner is involved.

These assessments, conducted within infant psychiatry in Ankara, address both the mother's treatment and the baby's developmental monitoring together. In the follow-up conducted by Assoc. Prof. Mehtap Eroglu, the baby's developmental milestones are also tracked, so that any delay is noticed early while the mother's treatment continues.

Useful to bring to the first appointment: pregnancy and birth records, the baby's health monitoring book, any recent blood tests and a list of current medications.

If you are seeking support through this period in Ankara, you can review our infant psychiatry service and request an appointment.

In Summary

Postnatal depression is a common, recognisable and treatable condition. What distinguishes it from the baby blues is that symptoms last more than two weeks and impair functioning.

Left untreated it affects not only the mother but the baby's emotional and cognitive development; what is decisive, however, is the duration and severity. A treated episode does not leave a lasting effect.

There are treatment options usable during breastfeeding, and the decision is made with the mother. It also occurs in fathers and should not be missed.

Thoughts of harming oneself or the baby, and signs of detachment from reality, require emergency referral.

For information about mental health assessment and early intervention in infancy, see our infant psychiatrist guide.