Postpartum depression remains one of the most common medical complications associated with childbirth, but it is often confused with natural fatigue or the so-called “baby blues”. The difference is not only about the intensity of the emotions, but especially about the duration and the impact on daily functioning. If the states of sadness, irritability or inner emptiness persist for more than two weeks and affect sleep, appetite, ability to concentrate or the relationship with the child, we are talking about a possible depressive episode that requires specialist evaluation.
According to the World Health Organization, postnatal depression affects a significant percentage of women in the first year after giving birth and can have serious consequences if left untreated, including risk of suicide in severe forms. Affection does not always show through obvious sadness. Many mothers describe constant irritability, disproportionate reactions, intense anxiety, intrusive thoughts or difficulty feeling joy – a symptom called anhedonia. Specialists explain the occurrence of postpartum depression through a combination of biological, psychological and social factors. Sudden hormonal declines after birth, sleep deprivation, and neurobiological changes that support attachment can increase emotional vulnerability. Added to these are personal history of depression or anxiety, changes in couple dynamics and lack of support. The desire to have a child and an uncomplicated pregnancy does not eliminate this risk.
In the interview given to “Weekend Truth”Oana Doruș, clinical psychologist and therapist through play and drama therapy, explains why postpartum depression does not always look like sadness, how it can also appear six months after giving birth, and why recovery – although possible – depends on one thing: asking for help in time.
“Weekend Truth”: How can a mother realize that it is not just fatigue or “baby blues”, but postpartum depression?
Oana Doruș: “Baby Blues” it is a very common phenomenon after birth and is manifested by emotional lability, easy crying, irritability, anxiety and difficulty sleeping. The key is that it usually starts quickly after birth and resolves within two weeks at most. But if the states of sadness, irritability or inner emptiness last more than two weeks and interfere with sleep, appetite, ability to make decisions or connection with the child, we are talking about a clear signal that there may be more than the usual adaptation. Postnatal depression can last for months and get worse if left untreated.
What are the most common warning signs that women tend to ignore?
Postpartum depression does not always appear as sadness, it can also frequently manifest as irritability, anger, disproportionate reactions, intolerance to crying or noises, continuous tension. Another underestimated sign is anhedonia: “I no longer enjoy anything”, including things that used to bring pleasure. Then there are intrusive thoughts and excessive anxiety (repeated child checks, catastrophic scenarios, hypervigilance), which can frighten the mother and keep her quiet for fear of being judged. In many cases, there is also the difficulty of connecting with the child: the care happens, but the state is more absent, without emotion. Guilt appears, thoughts such as “I’m not a good mother”, “I’m harming the child”, “others can do it, only I can’t”, shame and then isolation. Another obvious signal is related to lack of sleep, even when the baby is sleeping, the mother’s mind remains on continuous alert.
From biological to psychological factors
Is it normal for a mother to not immediately feel joy or connection with her baby?
It may be normal for joy not to appear immediately or for ambivalence to exist. The transition to motherhood is a major biological and psychological reorganization, and the parent-child bond is built through repeated interactions, mutual regulation, and caregiving experiences. However, it becomes worrisome when the detachment persists, is accompanied by distress, with decreasing functioning and prevents the mother from responding sensitively to the child’s needs.
Why does postpartum depression occur, even when the pregnancy was wanted and without complications?
Research over the last decade shows that the parent’s brain also changes during this period, thus supporting caregiving behaviors and sensitivity to the baby’s signals. These transformations can activate resources, but they can also expose vulnerabilities. The desire to have a child does not negate mental vulnerability. The onset of postpartum depression depends on a number of important and diverse factors that can activate simultaneously after childbirth. There are biological factors: sudden hormonal changes and, almost invariably, sleep deprivation, which affect emotional regulation and stress tolerance. Psychological factors are added: a history of depression or anxiety, early attachment experiences, perfectionism or self-criticism. The transition to parenthood frequently reactivates sensitive identity themes. At the relational level, couple dynamics change profoundly in the first year, and lack of support or conflicts increase vulnerability. Socially, isolation and pressure to be the “perfect mother” can amplify distress. These factors do not act separately, but compound: fatigue intensifies sensitivity, sensitivity increases tensions, tensions reduce support, and isolation deepens rumination. Postpartum depression can arise from this web of aggravating factors, even in the absence of medical complications.
On the edge of the precipice
Can postpartum depression still occur a few months after giving birth?
Clinical guidelines consider the period up to one year after birth to be relevant. Sometimes in the first weeks there is increased mobilization and support, and difficulties arise later when support runs out, lost sleep accumulates or pressures increase (return to work, conflicts, health problems of the child).
How serious can this condition become if left untreated?
Untreated, it can become chronic and worsen, affecting the mother’s functioning, the couple’s relationship and the interaction with the child. The WHO explicitly mentions the risk of suicide, ideas of self-harm in severe cases and the impact on functioning and the child. Separately, there is a rare but critical situation: postpartum psychosis, which is a psychiatric emergency (sudden onset, delirium/hallucinations, confusion, disorganization).
What impact does postpartum depression have on the mother-child relationship?
In the first year of life, the foundation of attachment is built through repeated interactions: the child signals a need, the parent responds, and from this sequence the feeling of safety develops. Postpartum depression can temporarily affect these exchanges. A decrease in emotional availability, difficulties in reading and responding sensitively to the child’s signals, and a decrease in pleasure in interaction are frequently observed. From an attachment perspective, parental sensitivity is essential for the formation of a secure attachment. When the mother is depressed, responses may become less consistent or less attuned, which may influence the child’s emotional regulation. However, attachment is a dynamic process, not a fixed moment. It is not single episodes that determine the relational pattern, but repetition over time. With appropriate early intervention (psychotherapy, parenting counseling, parent-child relationship support), sensitivity can increase and the relationship can reorganize in a healthy way.
Family support, essential
How should the partner and family react when they notice changes in behavior?
Through validation and concrete support. This means listening without minimizing, practical help to protect the mother’s sleep, involvement in the care of the child, facilitating access to specialized assessment.
What should we NOT say to a mother in this situation?
Messages that invalidate the experience and increase shame and loneliness, such as: “All mothers go through this”, “It’s just tired”, “You should be grateful”. Criticism, comparison, or pressure to “be positive” worsens the suffering. The right message is one that allows for feelings to be expressed and provides specific and applied support.
Psychotherapy, in the first line
When is it time for a mother to seek specialist help?
When symptoms persist and become more intense, when thoughts of self-harm occur, or when daily functioning is significantly impaired.
What are the treatment options and how effective is the therapy?
In mild and moderate forms, psychotherapy is considered first-line intervention. Interventions focused on the parent-child relationship may further support the quality of interaction and early emotional regulation. In moderate-severe forms, the psychiatrist can also recommend pharmacological treatment, with a careful evaluation of the risk-benefit ratio, especially in the context of breastfeeding. An important role is also played by psychosocial interventions such as support groups for mothers, structured parental counseling programs, educational and community interventions. Support groups reduce isolation, normalize experiences, and provide a space for emotional regulation through validation and sharing. For many mothers, this is the first accessible step to help. Individual parenting counseling can be helpful when difficulties are related to role adjustment, couple dynamics, or the relationship with the baby. This involves assessing the resources and vulnerabilities of the parent and the parenting couple, formulating clear goals and supporting the processes of emotional regulation and parent-child co-regulation. It is important to differentiate between parenting counseling (role and relationship oriented) and adult psychotherapy for older or deeper personal difficulties. In addition to these, it is recommended to look for a psychologist or psychotherapist with training in perinatal psychology, as well as interdisciplinary collaboration (psychologist – psychiatrist – obstetrician – family doctor – breastfeeding consultant), especially in cases with complex symptoms. The effectiveness of therapy is supported by data from international guidelines: most women with postpartum depression respond favorably to appropriate intervention. Recovery is not only possible but likely when there is proper assessment and support tailored to the real needs of the mother and family.
Can postpartum depression be prevented? Are there risk factors?
Prevention is not entirely possible, however, the risk can be reduced by identifying vulnerabilities (history of depression/anxiety, relational stress), implementing a support plan for the first months, early monitoring and screening, and if necessary, early interventions aimed at the parent-child relationship and supporting the parental couple. Postpartum depression is not a personal failure. It is a vulnerability that appears in a stage of massive reorganization. Most women recover and can build safe and healthy relationships with their children when they receive proper assessment and intervention.
