Postpartum depression: Not just for moms

By Tammy Worth

Rob Sandler likes to feel that he's in charge of his life. He likes to make plans, set goals for himself, and achieve them. And, for the most part, he was able to do that-until his son was born.

"You suddenly have no control over what you do," says Sandler, 38, a medical device sales rep in Houston. "You are totally dependent on what the baby needs, and when he needs it. Before, you are very in control of your life and time and calendar-all that changes so dramatically when you have a child."

By the time his son was 2 weeks old, this abrupt change and the feelings of "entrapment" it brought had made Sandler a wreck. He went from being excited and happy to overwhelmed, anxious, and sad. His appetite waned. He suffered from insomnia. He lost control of his emotions.

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Sandler started to feel that he was failing his son, and after another two weeks, the guilt led him to consult a psychologist. But even then, it took months-and an initial diagnosis of acute depression-for him to realize that what he was suffering from was postpartum depression.

Postpartum (or postnatal) depression is loosely defined as an episode of depressed mood that occurs in the weeks and months following the birth of a child, and, unlike the fleeting and more common "baby blues," persists for at least two weeks.

For obvious reasons, postpartum depression has traditionally been seen as a condition that affects women. Mounting research shows that the experience is not restricted to moms, however. Studies in recent years have found that roughly 10% of men become depressed when their partner is expecting or after bringing a baby home-not much lower than the rate of 13% to 14% seen in new mothers.

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Although the causes and symptoms of postpartum depression differ slightly in men and women (hormones may play a bigger role in women, for instance), the complications it can cause are similar regardless of sex and are no less serious a concern for dads. In addition to creating problems at work and with partners, postpartum depression can affect father-child bonding and can have consequences for a child's long-term development.

What male postpartum depression looks like
Postpartum depression appears to develop more slowly in men than it does in women. It has been shown to be most prevalent in men between three and six months postpartum, whereas women may experience its onset in a matter of weeks after birth.

The signs may be difficult to recognize at first. Men often display the textbook symptoms of depression (such as sadness, fatigue, appetite changes, feelings of worthlessness, and a loss of interest in things they used to find pleasurable). However, depression in men, more so than in women, sometimes manifests itself in unconventional ways.

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Men may grow angry and irritable, or they may become impulsive and drink or gamble too much, overwork, or even pursue an affair, says Will Courtenay, PhD, a psychotherapist in Berkeley, Calif., who specializes in men's health and is the author of Dying to Be Men: Psychosocial, Environmental, and Biobehavioral Directions in Promoting the Health of Men and Boys.

For Joel Schwartzberg, the telltale sign was his doughnut fixation.

"When I brought my son home from the hospital, the reality of that situation hit me like a wrecking ball," says Schwartzberg, 42, who has written about postpartum depression for magazines, websites, and in his book, The 40-Year-Old Version: Humoirs of a Divorced Dad. "I felt like in exchange for this wonderful little child, I had given up my life-and, at the time, it didn't seem like a fair exchange."

Although he didn't yet know that he was dealing with postpartum depression, he felt that his child was usurping the things he enjoyed (freedom, TV, sex), and he turned to food for solace. Specifically, to a 24-hour Dunkin' Donuts, where he would drive with his sleeping son late at night to give his wife a chance to rest.

"I knew I had a problem when my trips to the doughnut place became a regular occurrence," he says.

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The stress and anxiety Schwartzberg felt are common in men with postpartum depression, according to Courtenay. "They don't feel like themselves, and they think something is wrong," he says. "They should be happy about the child and experiencing baby bliss."

What causes it?
Many of the risk factors for depression in general also predispose men to postpartum depression. These include prior bouts with depression or other mental illness, a history of drug or alcohol abuse, recent life changes (such as a new job or moving to a new city), prior relationship problems, and a history of being abused.

One risk factor is especially common with a new baby in the house: lack of sleep. Depression and sleep problems often go hand in hand, and studies suggest that prolonged sleep deprivation is associated with changes in brain chemistry that increase the risk of depression. (But it has to be routine: Interestingly, one sleepless night has been shown to temporarily relieve postpartum depression.)

"Sleep deprivation can cause a mood or anxiety disorder in anyone," says Shoshana Bennett, PhD, a clinical psychologist in Sonoma County, Calif., and the author of Postpartum Depression For Dummies. "Fathers tend to participate more than in the past in parenting kids during the day and at night."

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The feelings of isolation that often accompany the early stages of child rearing can also contribute to postpartum depression. Men tend to have smaller social circles than women and rely primarily on their partners for support, Courtenay says. After a baby is born, a mother's attention is naturally focused on her child, and the father may feel he has lost his companion or is even being excluded.

"That really increases the isolation a man feels and that can compound and help set the stage for depression," Courtenay says. And, not surprisingly, if the mother experiences postpartum depression, the father is more likely to have it as well.

Finally, hormones may be partly to blame. Although the changes are far less dramatic than those new mothers experience following delivery, men's hormones can change before and after a birth as well.

Research-much of it in animals-suggests that testosterone levels dip and estrogen and prolactin (a hormone that helps make breast milk in women) increase in males before and after a partner gives birth. Men with postpartum depression may also exhibit postpartum drops in the level of cortisol, a stress hormone that drops in women postdelivery and has been identified as a possible factor in postpartum depression.

It's not entirely clear what precipitates these hormonal changes in men, Courtenay says, but it could be nature's way of making fathers more responsive to their children and "keeping them home" during a trying time.

The consequences
Postpartum depression-male or female-should not be brushed under the rug. If allowed to fester, it can cause relationship problems. Schwartzberg has written that the fraught time after the birth of his son delivered a "fatal hit" to his marriage. (He and his wife ultimately divorced.)

Research has also shown that the condition may have a detrimental affect on children, especially boys. A long-running study of parents and children from around the U.S. found that fathers who were depressed when their kids were 9 months old were less likely than happier fathers to play with their children outdoors. They were also less likely to read to their kids, at that age and at age 2-which may stunt a child's vocabulary, the study showed.

Language delays aren't the only fallout. A similar study in the U.K. found that children whose fathers experienced postpartum depression were roughly twice as likely as their peers to display emotional or behavioral problems (such as hyperactivity) at age 3, even when the mother's history of depression was taken into account.

Getting help
Nikki Wellensiek, a family health educator in Denver, Colo., recommends that new fathers seek treatment if they are still feeling sad and out of sorts one month after the birth of their child. Talk therapy can help, Wellensiek says, and antidepressant medication is sometimes appropriate.

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Sandler tried both, and within a couple of weeks he was feeling better. After about three months, he finally felt he was becoming the father and husband he wanted to be. (Sandler also got help from Courtenay and his website when working through his depression.)

"It is really important to realize you are not alone and you can get help," Schwartzberg says. "The hardest thing is when you are depressed and feel like you are the only one with the problem and there's nothing you can do about it."

Expectant dads, meanwhile-especially those who have a history of depression and are worried about a recurrence-should anticipate a bout of postpartum depression long before the baby arrives. Making an appointment with a health-care provider is a good place to start, and if you've taken antidepressants in the past, you may want to discuss the circumstances under which it would be appropriate to start again, Bennett says.

Get couples counseling to address any relationship issues and try to find sources of social support before the baby arrives, Courtenay suggests. Take a parenting class to meet other expectant fathers, for example.

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And remember, fatherhood-like anything else-benefits from practice. "Carve out some time to discover your inner dad," Schwartzberg says. "If you don't, you could end up feeling like a servant to both wife and child."