An Expert on Why Dads Get Postpartum Depression

We've all heard that women can become depressed after the birth of a child. But they may not be the only members of the family who have postpartum emotional difficulties. Every day in the United States, more than 1,000 men become depressed after the arrival of a new baby. In fact, says Dr. Will Courtenay, a psychotherapist based in Berkeley, Calif., who specializes in helping men with postpartum depression and runs the Web site, some studies show that the number may be as high as 3,000 per day, meaning that as many as one in four new dads could experience this problem—roughly the same as the percentage of women affected. Courtenay spoke to NEWSWEEK's Christina Gillham about the causes of postpartum depression in men, how to spot the signs and what to do about it. Excerpts:

NEWSWEEK: What kinds of men are most susceptible to postpartum depression?
Will Courtenay: Men who have a history of depression, or a man who has a rocky relationship with his partner or who is experiencing stress about becoming a father. Also, having a lack of support from others or economic problems can make a man more susceptible. It's likely that sleep deprivation also plays a major role in triggering men's depression. The thing that best predicts whether a man will become depressed, however, is whether his partner is depressed. Half of all men whose partners have postpartum depression are depressed themselves. Finally, men's hormones change, too, both during pregnancy and early in the postpartum period. Our testosterone levels go down, and our estrogen levels go up.

Why is that?
We don't know why, exactly. It depends who you ask. If you ask an evolutionary biologist, they'd say it's part of nature's way of keeping men around the home and the baby after the baby's born so they don't go running off.

You mentioned economic concerns. Is that because there's pressure on men to support the child financially?
Certainly some men still see their role as a primary breadwinner. And the economic concerns of raising a family certainly can contribute to men's anxiety, and that anxiety can then contribute to depression, but we don't have any good data on that. Any kind of stress, like economic stress, in combination with these other possible risk factors, can contribute to this development of depression.

What are the signs of postpartum depression in men? Are they different than they are in women?
When we think of a depressed person, we usually picture someone who's sad and crying. But if we picture instead a guy who's working 60 hours a week, is a little short-tempered, drinks a couple of beers at lunch, slips out of the office to have an affair, then speeds home to his wife, that's not what we picture when we think of depression, but those are some of the signs of men's depression, which can often look different.

Having an affair is a sign of depression?
Increased impulsiveness—whether it's having an affair, gambling, going on spending sprees or suddenly deciding to go off on a two-week backpacking trip with his best buddy—those kinds of impulsive decisions are one of the ways that men deal with depression. But that's not to say that we don't also see the classic signs of depression, which can include a sad mood, a loss of pleasure in hobbies or sex, a sense of worthlessness and thoughts of suicide. But we do have to remember that men are more likely than women to try and hide depression. So it's really important to look out for any sign of anything unusual.

Is there a problem with women not taking this issue seriously? Surely there are many who might think, "Hey, wait a minute—I went through the nine months of pregnancy, I went through the grueling labor, I'm staying up all night doing all the breastfeeding—and you're depressed?"
Yes. It speaks a lot to our cultural denial of men's depression in general. There's a lot of expectation and hope, especially in new moms, that when they go through this very powerful and oftentimes difficult transition into motherhood, that their husband, partner, spouse is going to be the rock and is there for them. And when he's not, it can create a lot of mixed feelings. That is something that makes it very difficult for men to come forward.

And how many men actually do come forward?
We don't know. More are coming forward, but we don't know.

One of the symptoms of women's postpartum depression is having negative feelings toward the child or wanting to hurt the child. Do men experience that too?
Of course. I think we need to keep in mind that we're talking about a very minute number of women who actually follow through on that. One of the things we hear from men is that they have difficulty hearing a child crying uncontrollably. It's one of the things that seems to stand out the most. There's a kind of helplessness that men are not used to experiencing. We like to feel confident, so when we can't make this helpless infant feel better it creates a lot of difficulty.

What kind of treatment is typically recommended for men going through postpartum depression?
What I recommend is that a man meet with a licensed mental-health professional and talk about what the range of options are for him. Some of the basic kinds of treatment for depression are probably still the best, the least invasive being exercise, to things like mindful meditation to medication. The biggest problem for many men is not the depression itself, but the fact that they think they can go it alone, that they can take care of this problem by itself. There are very serious consequences to men's depression that goes undiagnosed, the most serious being suicide. But short of that, it can have a huge impact on his marriage, on his career and on his kids.

We hear a lot about the "new dad" and how men are taking a more active role in their children's lives than their own fathers did. Do changing social expectations of the role of the father contribute to postpartum depression?
The changing role leaves a lot of dads uncertain about what they're supposed to do as a father. Most dads say, "Of course we want to be involved, but what does that mean?" They have no idea what that looks like, because most of these guys have had dads who had a completely hands-off approach to parenting. That uncertainly can quickly lead to anxiety, which often leads to depression.

What can men or couples do to prevent postpartum depression?
The best thing to do is address all of those potential risk factors or causes before they occur. So if a man has a history of depression, he should see a mental-health professional before his child is born and anticipate the possibility of his depression recurring. If he and his partner have a difficult relationship or poor communication, they should see a professional before the child is born. If the father has economic concerns about supporting his family, rather than avoid or put that off, he should look at his finances and set up a budget. Taking those steps can do a lot to relieve stress.