by Holly Keich
There’s a secret in our culture and it’s not about how strong women are in birth, it’s that men experience postpartum depression. Every day 1,000 new dads in the United States become depressed. 1 And some studies indicate that this is a low estimate and that it could be as high as 25% of new dads that experience paternal postpartum depression (PPPD).2 What these statistics tell us is that postpartum depression in men is common. But if it’s so common, then why haven’t we heard about it before now?
Traditionally, men have been conditioned to be the strong one, the provider for their new family. In fact, I recently came across a quote by Sigmond Freud that states, “I cannot think of any need in childhood as strong as the need for a father’s protection.” Because of this societal pressure, men tend to hide their depression and withdraw from others. There can be a disconnect as well between how men feel and how they think they should be feeling after baby arrives. Depression in men may also look different. Withdrawal may mean working more and spending more hours away from home. In fact, research tells us the men often experience depression in ways that are different than women. Men sometimes cope with their symptoms in different ways too. This may be why even trained mental health professionals may misdiagnose men’s depression.
It’s helpful to first look at the classic symptoms of depression which may also be present in men postpartum. 3
- Depressed, sad mood
- Loss of interest or pleasure
- Significant weight loss or gain
- Trouble sleeping or over-sleeping
- Restless feelings and inability to sit still or slow down
- Fatigue, loss of energy, or tired all the time
- Worthless or guilty feelings
- Impaired concentration and difficulty making decisions
- Recurrent thoughts of death or suicide
Typically a person would need to exhibit 5 or more of these symptoms over a 2-week period to be diagnosed with a depressed mood.
But as mentioned, there’s more to paternal postpartum depression in men. One thing that researchers are finding is that men don’t often acknowledge feelings of sadness, hopelessness, or guilt.4 They tend to have additional symptoms that are unique to men.
Symptoms of Men’s Depression 5
- Increased anger and conflict with others
- Increased use of alcohol or other drugs
- Frustration or irritability
- Violent behavior
- Losing weight without trying
- Isolation from family and friends
- Being easily stressed
- Impulsiveness and taking risks, like reckless driving and extramarital sex
- Feeling discouraged
- Increases in complaints about physical problems
- Ongoing physical symptoms, like headaches, digestion problems or pain
- Problems with concentration and motivation
- Loss of interest in work, hobbies and sex
- Working constantly
- Frustration or irritability
- Misuse of prescription medication
- Increased concerns about productivity and functioning at school or work
- Experiencing conflict between how you think you should be as a man and how you actually are
- Thoughts of suicide
The number of symptoms may vary as may the severity between individuals. While the list may seem daunting, the important thing to know is that depression is treatable. You can recover.
Because research on paternal postpartum depression is in its infancy, we know little about what exactly are the risk factors. What research is beginning to show is that many of the risk factors are similar to that of women. 6,7
- A lack of good sleep
- Changes in hormones
- A personal or family history of depression and/or anxiety
- Poor relationship with spouse
- Poor relationship with one or both parents
- Relationship stress – with a partner or with in-laws
- Excessive stress about becoming a parent or father
- Nonstandard family (such as being unmarried or a stepfather)
- Poor social functioning
- A lack of support from others
- Economic problems or limited resources
- A sense of being excluded from the connection between the mother and baby
- A personal history or alcohol or drug abuse
- A major life event such as a loss, house move or job loss
- Being a father of multiples or a baby with special needs
One risk factor that may have caught you by surprise was hormonal changes. We’ve all heard how fluctuations in hormones during pregnancy and after birth can affect women, but may not know that men have hormonal fluctuations during pregnancy and postpartum as well. Studies show that a man’s hormones also shift during pregnancy and after birth, for reasons that are still unknown. Testosterone levels drop; estrogen, prolactin, and cortisol go up. Some men even develop symptoms such as nausea and weight gain.8 According to Dr. Courtenay, a psychotherapist who specializes in men’s depression and host of postpartummen.com, one of the few websites devoted to the issue, “Evolutionary biologists suspect that the hormone fluctuation is nature’s way of making sure that fathers stick around and bond with their baby.”9
Another risk factor that may be surprising is that if your partner is depressed, there’s a good chance that you are too. Up to half of men whose partners have postpartum depression are depressed themselves.10 So it’s important that it’s not just the mother that gets assessed for PPD after baby, but their partner’s should too. The same tool can be used, the Edinburgh Postnatal Depression Scale – or the EPDS, for short. It is the most widely used assessment for postpartum depression and anxiety. It has been tested and found effective with men. You can find the PPPD assessment here.
*The instructions for completing the EPDS are different for women and men. If you are a woman and concerned that you have postpartum depression please use the following EPDS assessment from the postpartumstress.com.
According to the Journal of Parent & Family Health, fathers are most likely to experience the first onset of paternal postpartum depression in the first 3 – 6 months after the birth of their baby.11 This isn’t just a coincidence. It’s around this time that women in the U.S. end their maternity leave and head back to work, adding more stress to what is already a major life transition. As if figuring out how to parent isn’t complicated enough, returning to work adds one more thing to balance on an already teetering plate.
If you identify with the risk factors and are not yet pregnant, there’s time for preventative measures. Consult a mental health professional if you have a history of depression to prepare should you have a recurrence. If you have relationship issues or poor communication in your relationship, seeking help before the child is born can help you learn new skills which can lessen the stress and reduce your risk of PPPD. If there are economic concerns, it’s time to address them and set up a budget. Setting aside time to think through the logistics of postpartum can also be helpful. Postpartum Support Virginia offers an excellent, detailed plan for adjusting to life with a new baby.
If you’ve identified yourself or your partner in the symptoms for PPPD, then it’s important to get help. Depression is a very treatable condition, but if left untreated can result in damaging, long-term consequences for you, your kids, your marriage, your career, and your finances. Finding a therapist that is skilled in working with men is key in order to get an accurate diagnosis and appropriate treatment. You can ask your doctor or pediatrician for a referral. Be sure to ask when making an appointment if they have experience in treating paternal mental health. Therapy can also help you with stress management, juggling home and work responsibilities and relationship issues that can often come up when you and your partner are transitioning to parenthood.
There are other coping strategies as well that can be useful in conjunction with therapy:
Medication may also be suggested as a strategy and can be used short term to help to recover.
Tackle Isolation by reaching out to others. Talk with your partner or friends about the challenges of parenthood. This isn’t just a problem that effects you, it’s a family problem and sharing your feelings is a step to reaching out to develop a support network in your journey toward healing. If talking to those you know is too difficult, utilize online resources. postpartummen.com has a forum where men can share their feelings anonymously.
Take Care of Yourself physically and emotionally. Exercise, eating well, journaling, yoga, meditation, acupuncture – anything that reduces stress should be on every new parent’s to do-list.
Get Rest. Yes, we mean sleep. We know it’s at a premium these days, but figuring out a plan that works for both parents is imperative. Mood disorders can happen to anyone who is sleep deprived. Alternate nights taking care of the baby, hire a postpartum doula for a few nights or ask a family member to help so you can get some sleep. Allow yourself a break. Many men do double duty by going to work and then taking over childcare as soon as they get home. Discuss how you can share childcare and chores so you can have some down time.
Despite the secretive nature of PPPD it’s still a very treatable condition. Seeking help is imperative not only for your health, but also the well-being of your marriage and child(ren). If left untreated, research shows it can cause a negative impact on the emotional and behavioral development of your children years later.12 So the best thing you can do to provide for your children’s future is to get help for yourself today.
Holly Keich, LSW supports family connections through Om Baby Pregnancy & Parenting Center in Camp Hill, PA since 2008.