Postpartum depression in new dads: under-diagnosed and under-treated

Since the early 1990s there has been a growing body of research drawing attention to and appreciation of postpartum depression in new dads, according to Shannon Erisman, Ph.D., director of the Day Program at Women & Infants Hospital of Rhode Island. She explained that the birth of a baby represents a huge role transition, especially for first time parents.

For males, the transition may be especially difficult, particularly if they’ve had prior episodes of depression and are younger at the time of the birth. “Men who are younger than 25 are socially deprived, have less support and are at greater risk for postpartum depression. They’re transitioning into early adulthood and some are not ready for it. They may be in an extended adolescence,” Erisman said. “Becoming a dad awakens biological vulnerability.”

Un- and underemployment may be another stressor for the new dad. Erisman said that employers in the U.S. are just beginning to offer more parental leave benefits, but not as much as they do in other countries.
Erisman cited a meta-review of a large body of literature and found that prenatal and postpartum depression occurs in 10.4 percent of dads. “Typically, men experience depression at a rate of four to five percent,” she noted. At three to six months postpartum, one study shows the rate of PPD in men surges to 26 percent.

Also, when it comes to support, new moms have more access to occasions and situations involving other new mothers and socialization. Erisman suggested that new dads accompany the mothers to a therapy group or engage in couple’s therapy.

“Men don’t access treatment at the same rates as women. When women bring their male partners into therapy it gives the dads a forum to talk about how things are going. It’s also an opportunity to see what it could be like to be in treatment,” she said. “As we are becoming more aware of male PPD, stigma is being reduced and there will be more services accessed.”

Addressing male PPD is critical, said Erisman, because studies show that postpartum depression in males is related to increased hyperactivity and conduct behavioral problems when a child is evaluated at three-and-a-half years old. “And with men, depression in the postpartum period affects male children more than females,” she added.

Deborah Issokson, Psy.D., owner of Reproheart – Counseling for Reproductive Health and Healing in Pembroke and Wellesley, Mass., said that new dads who have depressive symptoms, which might include agitation, irritability, impulsivity, substance use and panic attacks, should seek treatment, although many do not.

“Men are not as likely to seek treatment and even less likely to seek someone to talk about postpartum depression,” said Issokson. She reported that clinicians suspect hormonal changes occur in men, such as a reduction in testosterone and an increase in cortisol, but don’t understand the impact chemical changes might have.

Finding an effective treatment for men with PPD can be challenging, Issokson pointed out. “Men should see a knowledgeable clinician. Clinicians who treat new dads with PPD should understand perinatal issues and address the context. If the male is struggling with the female having issues, the clinician needs to help the dad understand what the mom is going through. Integrated care is important,” she said, adding that 50 percent of men whose wives have perinatal complications will have PPD.

As researchers continue to study male PPD, Issokson anticipates more answers and more effective treatment options will emerge. “The public discourse is more about women, but we are talking more about men now,” she said, pointing out that postpartum depression may also occur in new dads who have adopted babies.

Kathleen Biebel, Ph.D., assistant director, Systems and Psychosocial Advances Research Center, associate professor, Department of Psychiatry, University of Massachusetts Medical School and program director, Massachusetts Psychiatry Access Project, reported that the months before a baby’s birth and the year following the event tend to leave the dads out of the picture.

Biebel explained further that pregnancy and childbirth is “mother-centric.” She said, “People are not asking about the dads. When the baby is born, the situation becomes baby-centric. Mom is the star and dad is like a walk-on. This could contribute to isolation and feeling more disconnected.” In conducting her research on perinatal depression in women, she has found few studies focused on dads.

Better screening efforts for depression in new dads, which is currently sorely lacking, would be a good first step in identifying a problem and then figuring out how to treat it according to Biebel.

“Providers are not talking to men about this huge life transition that can lead to depression. Women have multiple points of contact with their OB-GYN. But even if men go to the appointments, they’re not the patient so will not be screened,” Biebel said.

Additionally, no one is telling men it’s okay to be scared at the birth of a baby, Biebel noted. “People ask about the baby and the mom. The burden on men is quite significant,” she said. “Also men express themselves differently. This suggests that how we support them needs to be different. The first question is to screen the person.”

For the last 50 years, David C. Nichols, Ph.D., private practitioner in South Portland, Maine, has been treating postpartum depression and makes a point of involving both partners in treatment. “It doesn’t make sense to treat the woman and not the man. Even if the man is not a contributing factor, he is bound to be a force for change,” he said.

Nichols has found that when a new dad presents with PPD, his case reflects a “reactive depression.” He explained that new dads sometimes lose the close connection to their wives who are bonding with the baby. “The dads feel neglected, especially if the bond is not strong in the first place. They are overwhelmed with a feeling of responsibility and may lack self esteem and self confidence.”

Nichols advises a combination of medication and psychotherapy to address PPD in males. “Each alone is not that effective. The combination is better.”