The deep sadness experienced in the postpartum period is not always temporary "puerperal blues". Postpartum depression, which affects approximately 1 in 7 mothers, is a treatable disease. Recognizing the symptoms is the first step to getting help at the right time.
You may have dreamed for months about that first moment when you held your baby in your arms. However, if you feel a deep emptiness, a sadness you cannot explain, or endless anxiety instead of the happiness you expected in the days after birth, you are not alone and you are definitely not guilty. Postpartum depression is one of the most common medical complications of new motherhood. The good news is that it is a condition that can be recognized and treated.
In this article, we will explain what postpartum depression is, how it differs from temporary "puerperal blues", what symptoms it manifests itself with, why screening is important and scientifically based solutions. Most importantly, we will clearly state in which situations you need to seek help without delay.
Postpartum depression is a depressive disorder (a serious mental illness that affects a person's mood, thoughts and functionality) that occurs in the period after birth, lasts at least two weeks and negatively affects the mother's daily life, care for her baby and self-care. It's not just "being in a bad mood"; It is a medical condition that concerns the brain's systems that regulate mood.
Although symptoms usually begin in the first weeks after birth, they can occur at any time during the first postnatal year. In some women, depressive symptoms actually begin during pregnancy and continue after birth; For this reason, experts are increasingly using the term "perinatal depression" (depression covering the pregnancy and postpartum period), which considers pregnancy and postpartum together.
Postpartum depression is not a rare condition. Clinical sources and ACOG (American College of Obstetricians and Gynecologists) state that this disease affects approximately 1 in 7 women (about 10-15%) during pregnancy and the postpartum period. Current, comprehensive meta-analyses (statistical compilations that combine the results of many studies) worldwide have found the average rate even higher, at approximately 17-22%; Rates vary significantly by country's income level and geographic region, and are higher in low-income countries or rural areas.
Keep in mind: Postpartum depression is not a sign of weakness, incompetence, or "bad mothering." It is a medical condition that combines hormonal changes, sleep deprivation, genetic predisposition and life stress. Just like blood pressure or diabetes, it can be managed with appropriate help.
Emotional fluctuations in the first days after birth are very common and often normal. This is called "puerperal blues" ("baby blues" in English). Approximately 70-80% of mothers experience this condition. However, it is vital to distinguish between puerperal blues and postpartum depression, because the course and approach required are different.
In short: If sadness, hopelessness or anxiety does not go away or even increases two weeks after birth, this may be beyond the limits of "puerperal blues" and it is time to consult a health professional.
The symptoms of postpartum depression may vary from person to person and may not be seen all at once in every mother. It should be taken into consideration if several of the following symptoms persist for more than two weeks:
Important distinction — Postpartum anxiety and obsessive thoughts: In some mothers, the picture is accompanied by intense anxiety, obsessive worries and repeated checks with the fear of "some harm will happen to my baby." These involuntary, frightening thoughts do not reflect the mother's intentions; It is distressing and gets better when you get help. It is important that you share these with your doctor without feeling embarrassed.
Postpartum depression can affect any mother, but some circumstances increase the risk. Having these risk factors does not mean that the condition will definitely develop; they may simply call for closer monitoring and early preventive measures:
Postpartum depression often progresses silently; Mothers may hide their symptoms by saying "tiredness is normal" or out of fear of being judged. That's why screening (systematically assessing risk with short surveys, before symptoms are expressed) can be lifesaving. Screening does not diagnose; It identifies those at risk and directs them to detailed evaluation.
The two most commonly used scanning tools are:
ACOG's 2023 current clinical guideline recommends screening for mental health with validated tools at least twice during pregnancy and at the postpartum visit. ACOG does not favor any particular survey over another; Both EPDS and PHQ-9 are suitable options. EPDS is widely used in postnatal follow-up in Türkiye.
In terms of prevention, USPSTF (US Preventive Services Task Force) recommends that pregnant and postpartum women who are at risk for perinatal depression should be directed to preventive counseling initiatives (especially cognitive behavioral therapy and interpersonal therapy) before the disease even begins (level B recommendation). So, in some cases, it is possible to take steps before depression occurs.
Postpartum depression is a treatable illness, and with the right approach, most mothers recover fully. The treatment plan is determined individually by the physician, depending on the severity of symptoms, the mother's preferences and breastfeeding status. The main approaches are:
It is generally the first choice for mild and moderate cases. The two methods that have accumulated the most evidence are:
In moderate-severe cases or when therapy alone is not sufficient, the physician may recommend antidepressant treatment. The most commonly preferred group of medications are known as SSRIs (selective serotonin reuptake inhibitors — a class of antidepressants that regulate the balance of serotonin in the brain).
In breastfeeding mothers, sertraline is often preferred because it is one of the options that passes into breast milk the least and has the lowest risk of side effects in the baby. However, only your physician decides which medicine to use, in what dosage and for how long. Do not start medication or discontinue an existing treatment without consulting your doctor; Because stopping effective treatment suddenly may lead to a relapse of the disease.
Breastfeeding and antidepressants: Many mothers worry that "if I take medication, I will not be able to breastfeed." However, in many cases, it is possible to use an appropriate antidepressant while continuing breastfeeding. The decision should be made together with your physician, weighing the benefits and possible risks of the drug.
In recent years, a new class of drugs called neuroactive steroids, which regulate the GABA system in the brain, has been developed specifically for moderate-to-severe postpartum depression. Of this class, zuranolone (trade name Zurzuvae) became the first oral (pill) drug approved by the US FDA for postpartum depression in 2023; It is used as a short cure of 14 days. Brexanolone, from the same class, which was previously administered as a long-term intravenous infusion in the hospital, was withdrawn from the market by the manufacturer in 2025; Therefore, the prominent option among neuroactive steroids in current practice is oral zuranolone. According to UpToDate's current review, zuranolone can be considered as one of the first treatment options as it can provide rapid response, especially in cases of severe postpartum depression with no previous history of depression; Since the most common side effect is drowsiness (sedation), it is recommended to avoid driving for at least 12 hours after taking the medication (FDA box warning). The suitability and accessibility of this treatment varies by country and requires physician evaluation.
While not a substitute for professional treatment, there are important steps that support the healing process:
⚠️ If you have any of the following conditions, DO NOT WAIT — get emergency medical help immediately (contact the nearest emergency room or call your local emergency number (112 in Turkey) in Türkiye):
Having these thoughts does not make you a "bad mother." These are symptoms of an illness and can be controlled with immediate help. Don't be alone; Make sure someone you trust is with you.
Postpartum depression affects not only the mother but the entire family. Spouses, family members and close circle play a very important role in recovery:
Postpartum depression is a common, real and treatable illness. Its difference from temporary postpartum blues is that it lasts longer, is more severe, and disrupts daily life. Simple screening tools such as EPDS and PHQ-9 enable early detection; Most mothers regain their health with psychotherapy and, when necessary, medication under the supervision of a physician.
If you have noticed the symptoms described in this article in yourself or a mother close to you, asking for help is not a sign of weakness, but a sign of maternal responsibility and courage. You can take the first step today by talking to your obstetrician, family doctor or a mental health professional. Healing is possible and you are worthy of it.
Last updated: . This content has undergone scientific verification and is not a substitute for a medical examination.