Sometime after your bundle of joy arrives, you notice negative changes in your husband’s behavior. It could be paternal postpartum depression. And yes, it’s real.

 

When his first child was born in October 2013, David Levine, was thrilled. “I was as excited as any new parent and looking forward to being a dad,” says Dr. Levine, a pediatrician who practices in Westfield, New Jersey.  Within days his initial elation eroded, replaced by anxiety and fear.

His son, Zachary, cried constantly. As a pediatrician, Dr. Levine often comforted anxious parents and crying babies. But in his new role as a father, his medical training couldn’t rein in his obsessive fear that Zachary’s persistent crying indicated a serious medical issue. “I became fixated on the idea something was devastatingly wrong with my son.”

At work, Dr. Levine rallied engrossed in his practice. Back home in the couple’s small apartment he was irritable and even angry. “Every time I’m with him he’s crying,” Dr. Levine told his wife, “And now I’m even more convinced there’s something terribly wrong with him.”

His wife and his son’s pediatrician tried to reassure him. They didn’t succeed. “No one could persuade me that my son was fine,” he says.

Then when Zachary was but a few weeks old, Dr. Levine became convinced that the baby hated him. “He cries as soon as I walk in the door,” he told his wife who pointed out that the baby was too young to hate anyone. Feeling isolated and rejected, Dr. Levine became “verbally vicious” to his wife and demeaned his son constantly. “Maybe he’s autistic,” he told her, “hammering the point home day after day.” As the weeks went by his thoughts and feelings about, and towards his son, get darker.  “I hate him. I wish we’d never had him,” he told his wife.

Hidden Diagnosis

post partum depression in menThough he didn’t realize it at the time, Dr. Levine was displaying classic symptoms of paternal postpartum depression (PPPD). While women tend to turn their sadness and fear inward, men are more likely to express depression through anger, aggressiveness, irritability and anxiety, says San Diego-based psychologist David Singley PhD, who has treated roughly 40 men with postpartum depression. “They are also susceptible to other manifestations such as increased use of substances (drinking, drugs), addictive behaviors such as gambling or video games as well as physical manifestations like headaches and stomach problems.”

Something’s Wrong

At some point during those weeks, Dr. Levine googled paternal postpartum.  “I found out it existed,” he says, “but still I didn’t seek help.”  For men going from dude to dad is very different from any other event in their lives,” explains Dr. Singley, a member of the board of Postpartum Support International, an organization that provides resources and information about PPD. “And those old-school expectations that men are the protectors and providers keep men from seeking help.”  Dr. Levine’s reluctance to reach out to a professional was tied into his feelings about masculinity. “I didn’t want my wife to see me as weak and helpless,” he says. “I was supposed to be the strong one.”

Stuffing his emotions made things worse. His dark moods led to dark, intrusive thoughts. When he put his son into his highchair, Dr. Levine worried he’d been too rough or had shaken him. And he confesses there were moments when his suppressed anger scratched so close to the surface that had to walk away from his son.

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Breaking Through

When Zachary was about five or six weeks old, Dr. Levine and his wife planned an outing while Zachary’s grandparents were babysitting.  But that morning, “I said something really horrible to my wife about the baby,” he says. Driving to work, he suddenly felt terrified that this time he had gone too far. He pulled over to call his wife to apologize and to ask if their date was still on.  He thought she said “no.”  (She didn’t.) Convinced that she was rejecting him, Dr. Levine burst into tears.

That breakdown led to a breakthrough. He finally shared his despair, feelings of disconnectedness and fear with his wife. Her response was reassuring. “You need help. And you need rest. You’re falling apart,” she told him.  That very day he hired a night nurse. And he made an appointment to see a mental health practitioner in his practice who specialized in postpartum depression. (He was the therapist’s first male patient.)  Over the next three months, the cognitive therapy helped him understand that his obsessive negative thoughts were not based in reality. His son didn’t hate him. His son hadn’t rejected him. His son was healthy and thriving.

Still, he never told his therapist or his wife about his darkest thoughts.  “I didn’t want anyone to think my son was in [any] danger.”

By the time Dr. Levine’s wife went back to work and his month-long paternity leave started, Zachary had “matured and stopped crying constantly,” says Dr. Levine.  “He ate well for me and he was smiling at me more.” His confidence as a parent grew. Feeling much better, he stopped therapy.

The Science of Sad Dads

Dr. Levine is not alone. According to a study published in 2010 in the Journal of the American Medical Association, 10% or 1 in 10 men around the world experience paternal postpartum depression (PPPD). The study, a meta-analysis (a statistical analysis that combines the results of multiple scientific studies) involved over 28,000 participants in 43 studies conducted between 1980 and 2009. The study also reported that the incidence “was relatively higher in the 3-to 6-months postpartum.”

And while hormone levels are considered a major factor in female postpartum, another study found that men with PPPD may also be experiencing some hormonal mayhem. The 2017 study found an association between lower testosterone levels and PPPD. According to the study, “Following the birth of an infant, decreases in testosterone and increases in depressive symptoms have been observed in fathers.”  Why testosterone dips isn’t yet understood.

Hormones may play a part but the strongest predictor of male postpartum is female postpartum. If the wife is depressed, the man is twice as likely to develop postpartum according to a 2004 review of 20 studies. Researchers concluded that “during the first postpartum year, the incidence of paternal depression ranged from 1.2% to 25.5% in community samples, and from 24% to 50% among men whose partners were experiencing postpartum depression. Maternal depression was identified as the strongest predictor of paternal depression during the postpartum period.”

While the research confirms that male PPPD is real, the majority of men don’t know about it. The real challenge is two-fold: making men aware and helping them get help. And that’s precisely what Dr. Levine hopes to do by telling his story

One More Time

In October of 2017, Dr. Levine, now 40 and his wife, 38 welcomed their second child, a daughter named Alexandra.  His plan was to start therapy before the baby was born but as the birth approached, a death in the family sidetracked him. “My mind was preoccupied with other things,” he says.

Although he went into therapy when his daughter was four weeks old, some of the old feelings and anger reemerged.  “It all came to a head a couple of months ago,” he said. He found himself saying terrible things about his daughter in front of his son who said, “that’s not nice, daddy.”  “I couldn’t believe I’d let it happen again,” he says.  But this time he didn’t withdraw or try to hide his feelings from his wife.  Thanks to the cognitive therapy he’s “better at curtailing intrusive negative thoughts,” he says. “Now I believe that things will get better.”

Symptoms

According to Pacific Post Partum Support Society, common signs of postpartum depression and anxiety in men are:

  • Increased anger and conflict with others
  • Increased use of alcohol or prescription/street drugs
  • Frustration or irritability
  • Violent behavior
  • Significant weight gain or loss
  • Isolation from family and friends
  • Being easily stressed
  • Impulsiveness or risk-taking (this kind of behavior can include reckless driving or extramarital affairs)
  • Feeling discouraged; cynicism
  • Increase in complaints about physical problems, like headaches, digestion problems or pain
  • Problems with concentration or motivation
  • Loss of interest in work, hobbies and/or sex
  • Working constantly
  • Concerns about productivity and functioning at work or school
  • Fatigue
  • Feeling sad or crying for no reason
  • Conflict between how you feel you should be as a man and how you are
  • Thoughts of suicide or death

Where to Get Help

Once a month Dr. Singley hosts an hour-long call-in forum where men can get support from an expert and from one another about adjusting to and dealing with the pressures of parenthood. You can also visit the websites below for more information on postpartum depression in men:

Last Updated: Jul 20, 2018