Many women, in the initial period after childbirth, suffer from postpartum depression. Lesser-known reports state that new fathers too can experience postpartum depression. This usually occurs in two phases: (a) During pregnancy- first trimester and (b) After childbirth- 3 to 6 months after birth, with as many as one in four dads experiencing the symptoms.
Several studies have examined the epidemiology, risk factors, treatment and adverse effects of postpartum depression (PPD) in women; however, the condition is less understood in men. According to a research published in the Journal of the American Medical Association, about 10% of fathers become depressed before or just after their baby is born.
Five (or more) of the following symptoms are often present:-
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observations made by others (e.g., appears tearful).
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation)
- Significant weight loss when not dieting or weight gain (e.g., a change of more than five percent of body weight in a month), or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia
- Psychomotor agitation with sudden outbursts, anger or violent behavior or psychomotor retardation i.e. being slowed down
- Fatigue or loss of energy
- Physical symptoms such as headaches, muscle aches, stomach, or digestion issues
- Feelings of worthlessness or excessive or inappropriate guilt (which might be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- Diminished ability to think or concentrate, or indecisiveness (either by their subjective account or as observed by others)
- Recurrent thoughts of death or recurrent suicidal ideation
These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The episode is not attributable to the direct physiological effects of a substance or to another medical condition.
A variety of factors can play a role in developing prenatal or postpartum depression:-
- Hormones: Research shows that fathers experience various hormonal changes, particularly declines in testosterone during and after their partner’s pregnancy.
- Partner’s depression: At least half the number of men with depressed partners show signs of depression as well.
- Feeling disconnected from mom and baby: New fathers want to be a part of the newborn experience, but they often feel left out.
- Personal or family history of depression: Any history of depression or other mental illness increases the risk of prenatal or postpartum depression.
- Psychological adjustment to parenthood: Becoming a parent can be overwhelming as it requires significant coping skills with the change.
- Sleep deprivation: Lack of sleep is often underestimated by most new parents. Sleep deprivation can play a large role in developing symptoms of anxiety and depression. Some other factors that may contribute to paternal postpartum depression include having a colicky or premature baby, financial stress, relationship problems, recent loss or trauma, and lack of social support for parenting, such as not having parental leave at work.
Postpartum depression is often diagnosed through clinical interviews with the healthcare provider. Screening tools like the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) or the Edinburgh Postnatal Depression Scale (EPDS) can be used to support the diagnosis and assesses postnatal depression and anxiety in men and women. Men might be less expressive about their feelings and thus underreport symptoms, hence the scale uses a lower cut-off score for men.
If the father cannot be directly assessed, the EPDS-Partner (EPDS-P) can be completed by the partner as a screening tool. Alternatively, the Patient Health Questionnaire (PHQ-9) also demonstrates validity when screening for paternal postpartum depression.
What to do in case you are suffering from/ likely to suffer from paternal postpartum depression? – Talk to your health care professional. Treatments and supports provided to fathers are similar to those provided to mothers with postpartum depression.
Depending on the situation and the severity of depression, the healthcare provider may prescribe medication, psychotherapy, or a combination of both.
- Focusing on self-care:-
- Eat well and at regular intervals.
- Exercise regularly.
- Get adequate rest.
- Avoid habits like drinking and smoking
- Talk about your feelings- whether it’s with your partner, parent, sibling or friend (or anyone who will listen without judgment like your healthcare provider).
2. Serotonin reuptake inhibitors (SSRIs) are commonly used medications for postpartum depression. Antidepressants and other medications may also be considered for men with postpartum depression.
3. Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are psychotherapies known to relieve symptoms of postpartum depression. Individual or couples therapy can also help relieve symptoms.
Male postpartum depression can go undiagnosed for many months or years, but it is easily treatable. Clinicians are encouraged to screen for depression in fathers, particularly during the first year postpartum, especially if anxiety or risk factors are present. Antidepressant therapy or psychotherapy have been shown to be effective treatment modalities. Recognizing and treating paternal postpartum depression can improve the quality of life for the father and the family unit and decrease the risk for emotional and behavioural problems in children.
1) Journal of Affective Disorders, 28 Oct 2019, 263:491-499
2) https://health.clevelandclinic.org/yes-postpartum-depression-in-men-is-very-real/ 3) Innov Clin Neurosci. 2019 May 1; 16(5-6): 11–14.
4) https://utswmed.org/medblog/paternal-postpartum-depression/ 5) https://www.youtube.com/watch?v=YDxpNRoXsp0&t=3s