Richard A. Friedman, MD, for The New York Times: The pregnancy was easy, the delivery a breeze. This was the couple's first baby, and they were thrilled. But within two months, the bliss of new parenthood was shattered by postpartum depression.
A sad, familiar story. But this one had a twist: The patient who came to me for treatment was not the mother but her husband.
A few weeks after the baby arrived, he had become uncharacteristically anxious, sad and withdrawn. He had trouble sleeping, even though his wife was the one up at night breast-feeding their new son. What scared her enough to bring him to my office was that he had become suicidal.
Up to 80 percent of women experience minor sadness -- the so-called baby blues -- after giving birth, and about 10 percent plummet into severe postpartum depression. But it turns out that men can also have postpartum depression, and its effects can be every bit as disruptive -- not just on the father but on mother and child.
We don't know the exact prevalence of male postpartum depression; studies have used different methods and diagnostic criteria. Dr. Paul G. Ramchandani, a psychiatrist at the University of Oxford in England who did a study based on 26,000 parents, reported in The Lancet in 2005 that 4 percent of fathers had clinically significant depressive symptoms within eight weeks of the birth of their children. But one thing is clear: It isn't something most people, including physicians, have ever heard of.
At first, my patient insisted that everything was just fine. He and his wife had been trying to conceive for more than a year. He was ecstatic at the prospect of fatherhood, and he did not acknowledge feeling depressed or suicidal.
Suspicious of his rosy appraisal, I pushed a little.
It turned out that he had just taken a new high-pressure job in finance six months before the birth of his son. Though he was reluctant to admit it, he clearly had more than a little concern about his family's financial future.
And he was anxious about his marriage and his new life. "We go out a lot with friends to dinner and theater," he said wistfully, as I recall. "Now I guess that's all going to end."
He had spent the nine months of pregnancy in a state of excitement about being a father without really registering what a life-transforming event it was going to be.
Unlike women, men are not generally brought up to express their emotions or ask for help. This can be especially problematic for new fathers, since the prospect of parenthood carries all kinds of insecurities: What kind of father will I be? Can I support my family? Is this the end of my freedom?
And there is probably more to male postpartum depression than just social or psychological stress; like motherhood, fatherhood has its own biology, and it may actually change the brain.
A 2006 study on marmoset monkeys, published in the journal Nature Neuroscience, reported that new fathers experienced a rapid increase in receptors for the hormone vasopressin in the brain's prefrontal cortex. Along with other hormones, vasopressin is involved in parental behavior in animals, and it is known that the same brain area in humans is activated when parents are shown pictures of their children.
There is also some evidence that testosterone levels tend to drop in men during their partner's pregnancy, perhaps to make expectant fathers less aggressive and more likely to bond with their newborns. Given the known association between depression and low testosterone in middle-aged men, it is possible that this might also put some men at risk of postpartum depression.
By far the strongest predictor of paternal postpartum depression is having a depressed partner. In one study, fathers whose partners were also depressed were at nearly two and a half times the normal risk for depression. That was a critical finding, for clinicians tend to assume that men can easily step up to the plate and help fill in for a depressed mother. In fact, they too may be stressed and vulnerable to depression.
And there is the child to think about. Research has clearly shown that maternal postpartum depression can impair the emotional and cognitive development of infants. A father could well buffer the infant from some of the adverse effects of maternal depression -- but that is a tall order if he too is depressed.
Dr. Ramchandani, who also followed children for three and a half years after birth, reported that they were affected differently depending on which parent was depressed. Maternal postpartum depression was associated with adverse emotional and behavioral effects in children regardless of sex; depression in fathers was linked only with behavioral problems in boys. (The study did not report on possible effects when both parents were depressed.)
As for my patient, he recovered within two months with the help of psychotherapy and an antidepressant. Afterward, he summed up the situation in just 10 words: "And I thought only women get this kind of thing."
All too many doctors think so too.
Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.
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