As we approach Father's Day, on Sunday, June 17th, many fathers will be celebrating this special day for the first time. Kathy Morelli interviews Dr. Courtenay in a two part series on Paternal Postnatal Depression, a little discussed but often significant situation that can develop, as a man moves into fatherhood. Part two of this series can be found here.

Part One of an Interview with William Courtenay, Ph.D., LCSW, about Paternal Postnatal Depression - Signs and Causes

What is Paternal Postnatal Depression?

Paternal Postnatal Depression (PPND) refers to a depression that a father experiences within the first year after his child is born. PPND is different from the "daddy blues" - which many new dads can experience. With normal postpartum stress or the daddy blues, a father's going to feel better when he gets a little extra sleep, when he goes to the gym, or when he has lunch with a buddy.

But with depression, these things won't make him feel better. With depression, the symptoms are more severe and they last longer. So, if the daddy blues last more than two or three weeks, a father's probably depressed - and he should get help from a mental health professional who specializes in working with men. Left untreated, postpartum depression often worsens.

It's also important to point out that, even if new fathers don't have "clinical" symptoms, they can sometimes just feel miserable - and completely alone in their misery. It's not uncommon for me to hear from men, "I just don't feel any connection to my baby." For some men, it's even harder than this: they can't stand to be near their baby. They can't stand the smell of their baby. Or, for other men, they can't stand to hear their baby cry; just hearing their baby cry makes them completely crazy. And then, on top of that, these men feel horribly guilty for thinking or feeling these things.

What are the signs?

The signs of PPND aren't always easy to spot. When we think of a depressed person, we usually picture someone who's sad and crying.

But picture instead a guy who's irritable and angry, working constantly, withdrawing from others, or drinking or gambling too much. These are some of the ways men can experience and cope with depression differently than women.

A man who's depressed won't experience all these symptoms. Some men experience only a few of them, while others experience many. And how bad these symptoms get also varies among men - and over time.

Here are some symptoms of men's depression:

• 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
• Impulsiveness and taking risks, like reckless driving and extramarital sex
• Feeling discouraged
• Increases in complaints about physical problems
• Problems with concentration and motivation
• Working constantly
• Misuse of prescription medication
• Fatigue
• Experiencing conflict between how he thinks he should be as a man and how he actually is

Now, that said, it's important to point out that men with PPND can also experience "classic" symptoms of depression - such as a sad mood, loss of interest in hobbies or sex, a change in appetite, a sense of worthlessness, poor concentration, and thoughts of suicide. Certainly if a man is thinking about suicide, that would qualify as a psychiatric emergency. We have to remember that men commit suicide anywhere from 4 to 12 times more often than women do. Each day, 75 men in the United States take their own lives. So, any thoughts of suicide in men need to be taken very seriously.

It's important to keep in mind that men are more likely than women to try to hide their depression. And many men are very good at this. In fact, they're so good at it, they don't even recognize their depression themselves. So, looking out for any sign of something unusual is critical. The best sign might simply be hearing from his partner, "Honey, you haven't been yourself lately."

What are the Causes?

We're just beginning to understand the possible causes of PPND. It's likely that sleep deprivation plays a major role in triggering men's depression. We know that normal, healthy adults who are deprived of good sleep for just one month begin to develop all of the clinical signs of depression. So, sleep deprivation is a very likely cause.

Hormones may also play a role. Everyone knows that pregnant women and breastfeeding mothers go through hormonal changes, but men's hormones change too. A man's hormones change both during his partner's pregnancy and early in the baby's infancy. And it's a double whammy: not only do men's testosterone levels go down, but - at the same time - their estrogen levels go up. Which means less male hormones and more female hormones coursing though their bodies. One man was so relieved learning this, because he finally had an explanation why he'd suddenly "broke down in tears" when he saw a squirrel on the street get hit by a car. These hormonal changes can wreak havoc on a man's life, and may help set the stage for postpartum depression. In fact, there is some evidence linking decreasing testosterone levels with increasing risk of depression in men.

Now, the thing that best predicts whether a man will become depressed is whether his partner is depressed. Half of all men whose partners have postpartum depression are depressed themselves. Part of what I think explains this, is the new father's loss of his partner to her new job that keeps her occupied 24/7 - and being left on the sidelines while mommy and baby are bonding. We know from lots of research that men have fewer friends and smaller social networks than women do, and that - for many men - their female partners are their primary source of support. The loss of this support - which, of course, is even greater when the mother is depressed - might be a trigger for depression in some men.

Here are some other things that may increase a man's chances of experiencing PPND:

• Personal history of depression
• Relationship stress - with a partner or with in-laws
• Excessive stress about becoming a parent or father
• A sick or colicky baby
• A lack of support from others
• Economic problems or limited resources

Have you had fathers reach out to you with the symptoms of PPND? Maybe you suffered from PPND when you became a father? Do you talk about this topic in your childbirth classes? Do you include resources for new fathers on your resource list, in case PPND affects someone in your class? Please share your story with us here.

Next post Dr. Courtney will discuss the ways a new father's partner can support him, and prevention of PPND.

References

Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1), 26-35.

Kim, P. & Swain, J. E. (2007). Sad dads: Paternal postpartum depression. Psychiatry, 4(2), 36-47.

Paulson, J. F. & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. Journal of the American Medical Association, 303(19), 1961-1969.

Paulson, J.F., Dauber, S. & Leiferman, J.A. (2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics, 118(2), 659-668.

Ramchandini, P. G., Stein, A., O'Connor, T. G., Heron, J., Murray, L., & Evans, J. (2008). Depression in men in the postnatal period and later child psychopathology: A population cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 390-398.

About Dr. Courtenay

Dr. Courtenay received his Ph.D. from the University of California at Berkeley and is a Licensed Clinical Social Worker. He has served on the clinical faculty in the Department of Psychiatry at Harvard Medical School, and the University of California, San Francisco, Medical School. He is the author of Dying to Be Men(Routledge, 2011). In 2004, he received the "Researcher of The Year" award from the American Psychological Association and the Society for the Psychological Study of Men and Masculinity. Visit Dr. Courney at saddaddy.com

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