It was two weeks following the birth of his son when Rob Sandler realized he felt trapped. He was at a get-together with his family and friends, and the feeling overcame him as soon as his best friends left. “I felt as if I was being left behind in this difficult phase of parenthood, and those feelings just spiraled more out of control and became more intense,” Rob says.
Rob suspected something was a bit off immediately, so he brought his feelings up with his wife. “I have an amazing, supportive wife, and she knew I was not myself pretty quickly. We talked about it a lot,” he says. Within a few days, he visited his previous psychologist along with a psychiatrist and was diagnosed with acute manic depression — or postpartum depression (PPD).
There is no “official” mental health diagnosis for postpartum depression in dads, also called paternal postpartum depression or paternal perinatal depression (PPND). However, studies do show that many dads suffer some form of depression after baby's arrival.
While PPD in dads is not well documented, an estimated 1 in 8 moms experience symptoms of postpartum depression, according to the Centers for Disease Control and Prevention (CDC). Meanwhile, research suggests that between 4 and 25 percent of first-time dads suffer from PPD.
Depression is also highly linked with anxiety; about half of people who are diagnosed with major depressive disorder are also diagnosed with at least one anxiety disorder. Another large analysis of 23 studies published between 1995 and 2020 involving more than 40,000 new dads found that nearly 12 percent of men experienced anxiety in the first year postpartum — about the same as estimated rates of postpartum anxiety in new moms.
"Anxiety is very treatable. But we know that anxiety postpartum that's left untreated often leads to depression," says Will Courtenay, Ph.D., a psychotherapist in private practice in San Francisco.
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Is PPD in dads on the rise?
According to Dr. Courtenay, there haven’t been enough studies to know if PPD in dads has actually been increasing over time. “Even though these studies existed, no one was talking about it,” he says. But based on his experience interacting with fathers in his practice and online, he suspects it may have.
Over a decade ago, Dr. Courtenay began noticing a trend of depression in new dads. After reviewing the research, he confirmed that many men do indeed suffer from postpartum depression. He ties the increase he noticed to the 2008 recession, when there was a big increase in stay-at-home-dads who suddenly became their kids’ primary caretaker after they lost their jobs. “These dads were not prepared for this,” he says.
PPD hits working dads today equally hard. Many struggle with a problem women face, too: finding work-family-life balance. Men feel under increasing social pressure to be involved in their children’s lives from the get-go as they and their partners go back to work. In addition, many of their own fathers had a very hands-off approach to parenting.
“They don’t know what being an involved dad looks like,” says Dr. Courtenay. This combination of factors, he explains, can create a lot of anxiety about Dad’s new role — and anxiety, in turn, often leads to depression.
More recently, COVID-19 has undoubtedly taken a toll on men’s postpartum mental health. While it’s too soon to know how the pandemic and quarantine measures affected PPD rates in dads, Dr. Courtenay says it likely had an impact.
“We do know that alcohol use increased significantly during the pandemic,” says Dr. Courtney, adding that men tend to drink far more than women. “Alcohol can compound the problems men experience with depression and anxiety that are associated with PPND,” he says.
There are numerous ways the pandemic could have impacted new parents’ mental health. With daycare centers and schools closed, both parents have struggled to be full-time caregivers.
Job loss and isolation, hallmarks of the pandemic, have also been linked to an increased risk of PPD in parents. “Men often rely on their co-workers and work environments to provide the social support that they need. When that’s gone, as men work less or from home, that can be a big loss that many men aren’t even aware of,” he says. “This can also really ‘bring home’ the absence of a spouse or partner who’s primarily focused on a newborn or young kids.”
Symptoms of PPD in dads
Research suggests PPD in men can occur anytime in the first year of a child’s birth.
The symptoms of depression in both moms and dads can include:
- A sense of worthlessness, guilt or inadequacy
- Feelings of hopelessness or sadness
- Irritability
- Trouble sleeping
- A loss of pleasure from or interest in formerly favorite activities
- Fatigue or loss of energy
- Difficulty thinking or making decisions
- Thoughts of suicide
Postpartum anxiety symptoms in both sexes include:
- Excessive worry about a baby’s health
- Racing thoughts
- Obsession with caretaking rituals
- Unwanted thoughts of accidentally hurting the baby
Men who suffer from PPD are also more likely experience:
- Alcohol or substance abuse
- Indecisiveness
- Limited range of emotion
- Rage
Indeed, depression in men often doesn’t necessarily look like a stoic partner breaking out in tears. “It can look like irritability and anger, working constantly, drinking, or gambling too much. These are the ways men experience and cope differently with depression than women,” Dr. Courtenay says. He adds that men are also more likely than women to experience physical symptoms, like stomach ache, that have no clear cause. That’s why it’s important to seek help if your partner simply doesn’t seem like himself.
For Rob, postpartum depression was a feeling of entrapment without an end in sight. “I wanted to be a father so badly, but I couldn’t stop thinking of just the negative, difficult things. I couldn’t look beyond the very moment I was in,” he says. “All of these feelings made me feel very anxious, sad, overwhelmed and guilty.”
Depression symptoms are sometimes subtle or hard to recognize.
Adam Busby, who stars in the TV show OutDaughtered on TLC and runs the blog ItsABuzzWorld, experienced PPD not long after the birth of his all-girl quintuplets, who spent three months in the NICU. He says it was a very gradual downslide.
“I withdrew from friends. I stopped doing things that I used to enjoy, like going to the gym and meeting up with buddies. My work performance started to suffer,” he says. “It seemed like my mind was always racing, and I no longer had the mental capacity to want to push myself at work.”
Dads may even try and hide depression because social pressure makes them reluctant to talk about their feelings. That means their partners may bring it up at first.
Adam says that his wife tipped him off to his PPD symptoms before he realized there was a problem. “Things had progressively just gotten worse and worse, to the point that other people around us were pulling my wife aside and asking what was wrong with me,” he says. He suffered from depression symptoms for two years before he began treatment, seeing a counselor for regular sessions and a psychiatrist for antidepressants. “They told me that more than likely I was suffering from PPD because of the extreme circumstances of our situation,” says Adam.
Though he never doubted the diagnosis, he was bothered by it. “Depression is something that I didn’t know much about, and when you don’t know a lot about something, your first reaction is to be scared of it and hide it from others. That’s what I did for a while.”
Causes and risk factors for PPD in men
Numerous factors can play into a person’s risk of experiencing PPD. Experiencing one or more of the following factors increases the risk of PPD in dads:
History of depression
Men who have undergone an episode of depression are more likely to experience PPD, and depression is also more likely if there’s a family history for both men and women. While Rob doesn’t suffer from chronic depression, “I get overwhelmed and I analyze a lot,” he says.
A partner who’s depressed
“Half of women who are depressed themselves also have partners who are depressed,” explains Dr. Courtenay. “That’s when you see the biggest impact on kids, so it’s really important to get treatment.”
Lack of sleep
When even healthy adults don’t get enough quality sleep for just one month, they begin to develop physical signs of depression. “There are real, neurochemical changes in the brain,” says Dr. Courtenay.
Hormonal changes
While most people are aware that new moms go through major hormonal changes during and after pregnancy, hormonal changes also occur in men. After baby is born, studies have shown that men’s testosterone levels drop and their estrogen levels rise.
“We know that men with lower testosterone levels are more responsive to a baby’s cries. We think this facilitates bonding between father and child,” says Dr. Courtenay.
Dads who have lower testosterone levels at nine months postpartum are at greater odds of experiencing PPD, while those with higher testosterone levels are more likely to experience parenting stress and partner aggression. “I refer to this as the goldilocks situation: You need to have just the right amount,” Dr. Courtenay says.
In addition, men’s cortisol (the stress hormone) and vasopressin (a hormone that helps regulate sleep) levels also change, while prolactin levels (the hormone that stimulates milk production in moms) increase — all of which may play a role in PPD.
Isolation
In the months after birth, new parents often have a harder time connecting socially as they adjust to caring for a new arrival around the clock. A 2016 study in new first-time moms found that perceived isolation from friends and family is a significant risk factor for PPD.
While women tend to have large social networks for support, men tend to rely mostly on their partners, explains Dr. Courtenay. That means new dads may feel like they don't have anyone to turn to following a baby’s arrival.
“Many men don’t realize they’re going to ‘lose’ their partner or spouse, since an infant requires 24/7 care,” says Dr. Courtenay. “When a partner is suddenly unavailable, that’s quite a big adjustment for a man to go through.”
Other factors that have been associated with an increased risk of PPD in dads include:
- Experiencing stressful events in the past year, such as a job loss
- Poverty
- Marital/partner conflict
- Unintended pregnancy
Preventing PPD in dads
While it’s impossible to predict whether or not you or your partner will be affected by PPD, it’s a good idea to prepare for the chance that you will be — ideally before baby arrives. Dr. Courtenay suggests the following tips:
- Line up a support network of family and/or friends. Be prepared to ask for help when you need it.
- Take steps to get your budget and finances in order before your due date, so you don’t feel overwhelmed by the new expenses involved with having a child.
- If you and your partner are going through a rough patch, seek counseling before baby arrives. Relationship problems can increase risk of PPD in both parents.
- If you have a history of depression, get a mental health care provider lined up before baby’s birthday, then keep an eye out for symptoms once baby arrives.
- Check if your hospital offers online or in-person parenting classes for dads-to-be; many men are anxious (whether or not they consciously recognize it) about becoming a dad. “It’s a great way to learn skills, meet other dads and build a community,” says Dr. Courtenay.
Treatment of PPD in dads
While it’s tempting to hope you can just “tough it out” and “beat” depression on your own, experts say it’s essential to seek treatment. “It can really mess up a man’s life to not get help,” says Dr. Courtenay.
PPD can affect a dad’s relationship with his partner, interfere with work and increase risk of suicide.
Treatment for PPD varies a lot from person to person, but the good news is that there is help. Many dads benefit from talk therapy alone, especially cognitive behavior therapy (CBT) and interpersonal therapy (IPT). “Even after a couple of meetings, a father often feels relief,” says Dr. Courtenay.
Other dads don’t find relief from therapy alone and require short- or long-term antidepressants, Dr. Courtenay adds. And all new parents can benefit from prioritizing sleep as well as regular exercise as much as possible, both of which can help relieve and even prevent depression.
Both Rob and Adam were treated with talk therapy in addition to antidepressants. Almost immediately, “I was able to share and get a better perspective on what was going on,” says Rob, who adds that he felt back to “normal” after about two months.
Adam was off of his medication within a year of starting treatment and feeling much more like himself. “I believe the biggest help was just owning up to it. Just talking about it with others was a huge step in my recovery. I no longer lived in fear of what others thought about me and it was easier to live with it,” he says. “PPD in dads is definitely a real thing and can happen to anyone. It’s okay to not be okay, and it could only get worse if you say nothing and just think it my go away on its own.”
Rob agrees that, stressing that this can happen to anyone and that it’s never your fault. “If you are hindered by becoming the best father and husband you can be because you feel overwhelmed, depressed, sad or whatever, it takes a stronger and better man to seek help to get better than it does to just ‘toughen it out’ and slip deeper. There is no shame in seeking help,” he says.
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