Breaking news. New dads get depressed, too. You might be surprised to read that fathers are afflicted by depression and anxiety during pregnancy and after birth at rates similar to those of new mothers.
Perinatal depression and postnatal depression, what’s the difference?
Research shows that both women and men can start to feel depressed during pregnancy. Pregnancy-related depression that begins before delivery is called perinatal depression. (Following the birth of a child is known as postpartum.)
Under either title, pregnancy-related depression affecting dads, known as paternal depression, has had a tough time getting respectful recognition. The lighthearted but condescending term “sad dads” is commonly tossed around.
In 2018, an episode of Jane the Virgin introduced the subject of paternal depression but wound up mocking the “supposed” victim of PPD. He was only faking the symptoms anyway…
Paternal depression for dads is real
Paternal depression is an authentic condition, and it is also widespread. In the United States, between 8% and 10% of new dads go through significant to severe bouts of depression compared to the 15% or so of new moms who suffer equivalent levels of depression.
Baby blues vs. depression
We need to differentiate here between a phenomenon commonly known as “baby blues” and legitimate depression, whether maternal or paternal.
Practically every set of new parents goes through a rough patch or two in the period just before and after the arrival of a brand-new and very needy third party. After all, a huge amount of role adjustment and priority resetting is both necessary and inevitable when a baby does a cannonball into the marital pond.
Some of the symptoms of baby blues are irritability, fatigue, and sadness. Depression symptoms are often more severe and include aggression, extreme stress, and potential feelings of detachment from the baby.
Baby blues often occur a few hours during the day and go away two weeks after delivery. Postpartum depression often occurs within four weeks to months after delivery and can last up to a year.
What are the risk factors for postpartum depression for dads?
Postpartum depression (PPD) can begin almost immediately after the new baby is delivered, and it can last throughout the first year of the infant’s life.
The most obvious source of paternal depression is all the disruption that necessarily accompanies the task of incorporating an utterly helpless and yet all-powerful third-party into the family dynamic. That disruption takes many forms.
No sleep for you
Sleep deprivation is a given for both new parents. And the lack of sleep is a huge factor in the causation of PPD. The impact of stress is multiplied when you’re exhausted.
The new father and male hormonal changes
There seems to be universal awareness that pregnant women go through vastly transformative hormonal changes, both during and after pregnancy.
A much less widely known fact is that men also undergo hormonal changes (specifically, a reduction in testosterone levels) in the time-period surrounding incipient fatherhood.
There are beneficial consequences to this drop in testosterone levels. To a new father, a baby can be a very threatening rival for his wife’s time, attention, and love. A natural male reaction to the arrival of such a threat would be to aggressively compete.
But less testosterone coursing through a man’s system leads to a corresponding reduction in hostility and aggression, as well as an increase in empathy and sympathy.
In short, nature makes a new father go through a hormonal change so he can stop acting like a man and be more like a woman. This temporary improvement enables him to create strong and loving bonds with his new child.
But accepted research shows that low testosterone in a man is directly linked to mood disorders and depression.
It’s a classic Catch-22. The poor guy can’t win. Well, it is possible for him to win, but it’s not easy, as we explain in the treatment section of this article.
There are plenty of other risk factors for PPD, too
Of all the risk factors associated with PPD, a wife with her own perinatal depression carries the strongest link to a new father’s depression. A meta-analysis of 20 studies showed that the husband of a wife with postpartum depression is twice as likely to develop his own PPD.
Just like all other forms of depression, PPD is a complex and intricate condition. Aspects such as the new father’s prior mental health history, ongoing marital discord, poverty, and whether the pregnancy was intended, can all play a significant role in the creation of paternal perinatal depression.
What are the symptoms of male postpartum depression?
Paternal depression is expressed in many ways. Some common depressive symptoms include:
- Constant dissatisfaction
- Risk-taking behaviors, such as substance abuse and alcohol overuse
- Detachment from the family
- Feelings of stress, frustration, and worthlessness
- Physical symptoms, like constant fatigue, headaches, weight gain, and stomach cramps
- Loss of interest in previous activities
- Thoughts of suicide
What are the adverse consequences of PPD?
Here’s where it really gets scary. Infants of depressed fathers themselves experience a higher level of distress. Research has shown that paternal depression adversely affects parenting behaviors and is associated with decreased sensitivity and increased hostility towards children.
Children who live with a depressed father have an approximately 50% increased risk of developing emotional or behavioral problems. Paternal depression is linked to delays in behavioral, emotional, and social development in four and five-year-old children.
It’s clear that untreated PPD creates negative energy that destructively rolls through both current generations and those to come. That’s why it’s a very good thing that effective treatment is available.
How is postpartum depression for dads treated?
The first step is the recognition that treatment is necessary. This step proves to be remarkably difficult for a great many new fathers. A new dad is apt to hide his depression from friends and family members, so any intervention from those sources is unlikely.
Mental illness issues of any sort are commonly perceived by men as a weakness. Fatherhood is supposed to be the best time of a man’s life, anyway. See a mental health professional because your dreams of having a beautiful family have come true? No way.
And why should the father need treatment, anyhow? After all, he didn’t house the new baby while it grew into a human. He didn’t go through all the inconvenience, discomfort, and pain that goes with pregnancy.
Many stalwart husbands believe that their task is to provide both practical and emotional support to their long-suffering wife, while they scrupulously avoid whining about their own misery.
This reluctance, or inability, of most men to recognize their own need for treatment makes universal screening for paternal postpartum depression essential.
Postpartum depression screening urged for new moms and dads
In 2019, the American Academy of Pediatrics (AAP) released a policy statement urging pediatric providers to recognize and manage perinatal depression.
But that recommendation doesn’t go far enough. The AAP statement acknowledges postpartum depression as an established clinical problem, but it calls for health care providers to screen only the maternal half of parenting partnerships at 1, 2, 4, and 6-month well-child visits.
The AAP suggests that pediatric providers “consider screening the partners as well”, but not until the six-month visit.
It is not acceptable to deal with the recognition and treatment of paternal depression as an optional add-on. Health care providers must screen parenting partners equally, regardless of gender or marital status, and make appropriate referrals for needed care.
Once the signs of paternal postnatal depression have been recognized in a new dad, help is available. PPD shares most of the characteristics of the more generalized sorts of depression. So recognized depression treatments, such as selective serotonin reuptake inhibitors, such as sertraline, are used as first-line treatment for PPD.
Psychotherapy modalities, such as cognitive behavior therapy and interpersonal therapy, have also been effective in alleviating depression. And support groups are invaluable, both in and of themselves, and as a pathway to individual treatment.
Support for men with PPD is available through:
About Dr. Thaïs Aliabadi
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