We've all heard about mothers with postpartum depression -- but did you know that fathers can suffer from it too? Parents investigates an increasingly common condition, one very few men can bring themselves to discuss.
Rob Sandler expected his life to be different after the birth of his first child, Asher, now 4. What he wasn't expecting was the overwhelming sense of helplessness and despair that soon swamped him.
"I was gung-ho as soon as I found out we were having a baby," says Sandler, of Houston. "I went to all the ob-gyn appointments and ultrasounds with my wife. I wanted to be hands-on with everything. But a week after we brought Asher home, I snapped. What should have been the happiest time of my life turned into a complete nightmare."
An admitted type-A personality who was used to being in control, Sandler was terrified by the changes in his routine. "I knew that stupid stuff like watching TV, going on the computer, or taking a nap whenever I wanted was over -- that was expected. But I was worried that I'd never get back to my hobbies, my friends, my extended family. I felt trapped and started spending longer hours at work because I didn't want to come home and be guilty about the way I was feeling. I was a very involved dad, but I still felt like a zombie going through the motions. I would cry, sometimes uncontrollably. It was brutal, and I honestly didn't think it would ever get better."
Doctors talk to new moms about postpartum depression (PPD), and some celebrities, including Brooke Shields and Gwyneth Paltrow, have publicly described the ineffable sadness, mood swings, and paralyzing anxiety that gripped them after they gave birth. But even people well-versed in parenting issues may not know that fathers can experience this too. This is largely because men themselves don't want to talk about it. (Indeed, in all my years as a reporter, I've never had a harder time finding men willing to speak on the record than I did for this story.) And the fallout can affect not only a new dad but his marriage and his child as well.
A report in the Journal of the American Medical Association found that 10 percent of men worldwide showed signs of depression, often referred to as paternal postpartum depression or PPPD, from the first trimester of their wife's pregnancy through six months after the child was born. The number spiked to a whopping 26 percent during the three- to six-month period after the baby's arrival. "That's more than twice the rate of depression we usually see in men," explains James F. Paulson, Ph.D., associate professor of psychology at Old Dominion University, in Norfolk, Virginia, and lead author of the survey, which assessed 43 studies of more than 28,000 fathers worldwide. "The fact that so many expecting and new dads go through it makes it a significant public-health concern -- one that physicians and mental-health providers have largely overlooked," says Dr. Paulson. This is what experts understand about the causes, symptoms, and treatment.
Silent Sadness
The best predictor of a man's risk of depression is whether his wife is also depressed. "Half of all men whose partners have postpartum depression are depressed themselves," says Will Courtenay, Ph.D., a psychotherapist in Oakland, California, and an expert on men's health. "Depression in both parents can result in devastating consequences for their relationship and especially for their children." Our society subscribes to the cultural myth that men should be stoic and tough things out, notes Dr. Courtenay. "So when men start to feel anxious, empty, or out of control, they don't understand it and they certainly don't ask for help." Women, on the other hand, tend to have a larger social network and share stories and strategies during pregnancy and life as a mom. Their husbands almost always assume they're alone in feeling sad or scared to be a dad.
"As much as I love my son, life was hell for the first few months," says Chris Illuminati, of Lawrenceville, New Jersey, who became a stay-at-home dad when Evan, now 3, was born. "What scared me were the crazy thoughts that ran through my head at 4 A.M. It was always the worst in the early morning hours. What if I just left him screaming like a car alarm and went to bed? If I was sitting alone with the baby in a dark room, it seemed I was the only person in the world awake. All you have are your thoughts, most of which are, 'God, I hope this gets better fast, because right now it sucks.' "
Conventional wisdom holds that a mother's PPD is triggered largely by hormonal fluctuations -- ammunition for those who insist that men couldn't possibly have this condition since they can't be pregnant or give birth. However, 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. "Evolutionary biologists suspect that the hormone fluctuation is nature's way of making sure that fathers stick around and bond with their baby," explains Dr. Courtenay.
Still, postpartum depression unfolds as the result of a complex interplay of factors, says Sara Rosenquist, Ph.D., a therapist in Chapel Hill, North Carolina. "Any parent facing the emotional and social upheavals that a baby ushers in is at risk for depression," she says, adding that adoptive parents are also certainly vulnerable. A shift in hormones is among many factors that can trigger depression in men as well as women who are predisposed to it. "But assuming that hormones are the single cause prevents us from finding the full cause -- and real solutions," adds Dr. Rosenquist, author of After the Stork: The Couple's Guide to Preventing and Overcoming Postpartum Depression.
Experts believe that PPPD may be more prevalent now largely because this generation of fathers is feeling the same psychological, social, and economic stressors that some mothers have long experienced. Eighty percent of people who lost their job during the recession were men, says the Bureau of Labor Statistics. With more moms working, dads are shouldering child care and household tasks that traditionally fell to women. They have plenty of stress and little sleep, and this, along with hormonal changes, can combine to create a perfect storm for depression.
"I don't think it's a coincidence that the rate of PPPD goes up sharply during the three to six months after birth, just around the time many women end their maternity leave and head back to work," notes Dr. Paulson. Problems that may have at one point been simmering on the back burner, or that simply were never discussed, can boil over when the question of who-does-what-when becomes more complicated.
When Dave Weber's daughter was born, he was blindsided by emotions he'd never experienced. "I was overwhelmed and didn't know how to climb out of it," says Weber, who lives in northern Ohio. "My wife and I had been so excited to have this baby. We thought we were ready, but nothing went as expected. Instead of a natural birth, Julie had a long, tough labor and eventually an emergency C-section. Nursing was painful, and the doctors didn't know why. She kept it up for nine months, often sobbing that she couldn't do it anymore and she thought she was losing her mind. I think deep down, I expected her to be the strong one who would always know what to do. I felt like a little boy, terrified because I couldn't make it better. If she couldn't take it, how could I?"
Telltale Signs
Depression in men often looks different than it does in women. While some men do exhibit classic symptoms of sadness, others become irritable, agitated, or angry, says Dr. Courtenay. Dads may have shortness of breath, heart palpitations, or full-blown panic attacks. Men may feel worthless; lose interest in sex or activities that used to bring them joy; or engage in such risky behaviors as abusing alcohol or drugs, gambling, or extramarital affairs. "Guys who suddenly start working 60 hours a week may also be depressed, since immersing themselves in their job is the way many men cope with stress," adds Dr. Courtenay.
All of the wives interviewed for this story said that the first thing they'd noticed was a personality shift in their husband. "By the third week, I realized that Dave was going through something well beyond the normal adjusting-to-a-new-baby problems," says Julie Weber. "I married Dave because he can make even a trip to the supermarket fun. But he became a shell of himself. He wasn't sleeping, and not because he was getting up with the baby at night -- I did that. He wasn't eating, and he didn't want to be around anyone."
Traci, Rob Sandler's wife, also noticed that her usually charming, life-of-the-party husband had become sulky and quiet. "The first week, Rob was fantastic with the baby," says Traci. "But by our second week home, even though he was still doing everything, I could tell he was on autopilot. I finally told him we needed to find out what's wrong and what we could do about it."
Indeed, even mild to moderate depression can have serious repercussions when it's not treated. "Although the effect of a father's depression on children is not as well documented as that of a mother's, we know that dads who are depressed are less involved with their kids, and that can lead to mild language delays, disruptive behavior, or a higher rate of social and emotional problems later on," says Dr. Paulson.
Dave Weber finally began to feel better when he was about four months into fatherhood, after he started seeing a therapist regularly and taking an antidepressant. "He began to enjoy the little things in life again," recalls his wife. "The smiles and laughter came back. When our daughter was born, everyone said she looked just like Dave, but he hadn't seemed to care. Then one day I looked on our computer and there was a picture of them cuddling side by side in our bed. Dave had Photoshopped his goatee on her face. That's when I knew the real Dave was coming back."
Sandler found that a combination of counseling, medication, and a supportive group of family and friends helped him gradually feel more grounded. At first, he went for twice-weekly therapy sessions, then once a week. He and Traci eventually went together every two to four weeks to iron out any problems in their marriage as they cropped up. "Whenever I would start to have those old feelings, I'd tell myself to take things one day at a time -- sometimes one hour at a time," he recalls. Before long, he was much calmer: "I felt like a different person." And by the time Asher turned 6 months, Sandler says, he was back to his old self.
Could your partner be depressed?
Watch out for these symptoms and speak with a doctor if you're concerned, suggests Dr. Will Courtenay.
- Has he become uncharacteristically irritable or agitated?
- Is he distancing himself from you and the baby?
- Is he gambling, drinking, taking drugs, or engaging in other reckless behaviors?
- Does he have a personal or family history of depression?
- Is he sad, tearful, or uninterested in doing things that he used to enjoy?
- Does he make comments that he feels worthless or shares suicidal thoughts?
- Does he spend more time than usual at work?
- Are you suffering from PPD yourself?
4 Coping Strategies
Talk About It
This is a family problem. "If I could give men one piece of advice, it would be to open up and communicate with your wife," says Rob Sandler. "Sharing your feelings doesn't mean you're whining or complaining. It means you acknowledge that there's a problem, you don't want to be this way, and you need to be a team in your new journey."
Take Care of Yourself
Exercise, eating well, journaling, yoga, meditation, acupuncture -- anything that reduces stress should be on every new parent's to-do list.
Consider Counseling or Medication
Professional help might include talk therapy as well as antidepressants or anti-anxiety medication for a few months. Ask your internist or pediatrician for a referral to a mental-health provider with experience in men's issues.
Check Out Saddaddy.com
This site provides facts about PPPD as well as an online forum where men share their feelings anonymously. The postings provide a vivid glimpse into the raw despair and guilt that some men feel.