(If you know someone or are personally dealing with postpartum mental health issues, know that you are not alone. Reach out to the NIMHANS Perinatal Mental Health Helpline - 8105711277 )
Childbirth is undoubtedly a joyous occasion. But it can be overwhelming, you're told, and prepared for it by those around you.
You read up, you listen, you take notes.
But something you're, perhaps, not prepared for is being weary of your own child, of parenthood, and the guilt that comes with feeling this way.
Sleeplessness, fatigue, hormonal changes, anxiety, financial strain, and emotional upheaval, childbirth brings all this and more, and adjusting to this dramatic new life change can be hard, not just for the mother but even for a new father.
'Baby Blues' and Beyond
Feeling overwhelmed in the face of such a life altering event is but natural. Many new parents will experience what is known as the 'baby blues'—bouts of crying, mood swings, anxiety, fatigue, feeling of hopelessness and worthlessness— in the initial few weeks after childbirth.
Around 50 to 75 percent of new moms are said to experience 'baby blues' in the first couple of weeks of motherhood. There is no conclusive data of this for new fathers.
“Just like any other mental health issue vs mental health disorder, when something is causing distress but not a significant amount of disorder, that’s when we call it ‘baby blue’, where it’s manageable, it's not of long standing, the symptoms aren’t severe, and it's not interfering with your daily work, your socio-occupational health or your interpersonal relationships," explains Dr Ruksheda Syeda, a psychiatrist and family councillor from Mumbai.
"When we talk about postpartum depression, it has crossed that threshold where the symptoms are disrupting daily functioning.”Dr Ruksheda Syeda
In Fathers Too
Studies suggest that, while up to 20 percent of new mothers go on to experience postpartum depression, the same is true for around 10 percent of new fathers.
"It definitely exists. We have documented evidence that around 6 to 10 percent of men can and do get diagnosed with postpartum depression," says Dr Syeda.
She underscores that this only refers to diagnosed cases.
The real numbers are likely higher considering historically men are to report mental health struggles, especially associated with depression, and sadness and worthlessness.
Legitimising postpartum depression in new mothers has been a long, winding battle in itself.
In fact, it was only in 2005 when actor Brook Shield released a powerful documentary recounting the details of the aftermath of her child's birth, that postpartum depression was for the first time publicly acknowledged and discussed.
In recent years, with more studies geared towards decoding the illness and more celebrities opening up about their own struggles, the topic is gaining momentum and empathy.
However, postpartum depression in men, and the repercussions it can have on the family unit's mental health is yet scarcely acknowledged.
Getting to the Bottom of PPD
What caused Postpartum depression?
While we still haven't quite unravelled the phenomenon, some studies point to the fluctuation in reproductive hormones during and right after pregnancy being a cause for Postpartum, or rather perinatal, depression in women.
This scientific validation, has been a huge driving force behind the legitimisation of PPD in women.
However, recent studies have found that new fathers, too, experience hormonal fluctuation.
"After a child is born, the father is also going to go through some hormonal changes," says Dr Syeda.
"Now these hormonal changes can be positive, can foster more bonding with the child, gentle parenting, more empathic parenting, or it can be negative and can trigger depression," she adds.
Though hormones do play a part in triggering PPD in women as well as men, to what extent is still unknown.
Experts agree that apart from physicochemical changes, social and psychological changes also have a great role to play in the onset of the 'baby blues' and postpartum depression.
"Studies have found that new fathers do exhibit a fluctuation in testosterone, estrogen, vasopressin, and prolactin. These may not be significant enough to cause any physical reaction but again clubbed with the other factors we mentioned, it might be enough to trigger depression."Dr Ruksheda Syeda
What are these other factors?
Genetic disposition to anxiety, depression
If the mother is going through PPD, the chances of the father having it is higher.
Social, psychological factors, including disonance between your expectations and reality.
"For instance, in India there more chances of a woman, especially, having postpartum depression after a girl child is born as opposed to after the birth of a boy child," explains Dr Syeda.
She goes on to talk about how Just like new mothers, new fathers can also get caught in a trap of self blame.
“A dissonance in expectations need not necessarily be only from childbirth, but also from your end. What you thought you would feel but are not.”
“Oh, I should have felt differently. I see other new fathers be so happy, and I don’t seem to be very happy.”—Such thoughts can further lead to guilt and shame.
Dr Samir Parikh, director, Department of mental health, Fortis hospital, adds to these causes saying, "the reasons for the onset (in men) are similar (as in women), which are sudden pressure, sudden change in sleep awake pattern, sudden realignment of life, all these factors are a result of the self taking time to adjust."
Postpartum, Postnatal or Just Depression?
In spite of ongoing research, postpartum depression is still a grey area, with many shades.
Some believe that the word 'postpartum' should not be used to refer to the stress new dads might feel because it is nowhere near what new mothers experience in terms of going through pregnancy and the process of childbirth.
Others believe the phenomenon itself should be collectively known as Parental Postnatal Depression, considering even adoptive mothers are known to experience postpartum depression.
Opinions of experts also vary on whether long term postpartum depression needs to be termed as such.
While Dr Samir Parekh acknowledges the onset may stem from childbirth, he stops short of calling it 'postpartum depression.'
"It is the 'blues' aspect that needs to be looked into here. If they are diagnosed with depression, whether it is postpartum or not, that does not change the treatment," he says.
"If this (baby blues) was to continue beyond the two weeks marker, and if that was severe, and all these significant symptoms were causing significant impairment in function, and one was to diagnose that the individual has depression, then it should be treated like any other depression."Dr Samir Parikh
Dr Syeda on the other hand is of the opinion that though the medication may be similar, the root cause makes it a whole other ballgame.
"When it comes to diagnosing PPD, the onset is what makes it distinct—few weeks to months of the baby being born. So it is essentially a major depressive disorder with postpartum onset."
“The causative factors and the social factors are very different so the approach will also need to be different. Maybe the medication we are prescribing may be similar, but the approach has to be different."Dr Ruksheda Syeda
Dr Syeda goes on to speak about how PPD in men may present itself differently than in women.
“PPD in fathers is diagnosed just like you would diagnose PPD in women. But of course because men and women are different beings so the presentation may be slightly different," she explains.
"For instance, in men, there might be more irritability and anger, it could be a slow and insidious progress of the illness.”
According to studies, men going through 'baby blues' or PPD are more likely to turn hostile, having angry outbursts and creating conflict.
Both Dr Syeda and Dr Parikh, however, agree that there is a need to recognise childbirth as being a significant event that can impact the mental health of both parents.
"It is important to recognise PPD only because we need to recognise the fact that fathers can also have an adjustment time postnatal, which is why support systems are important," says Dr Parikh.
“Yes, it is important to recognise childbirth as a significant event or a psychosocial event in an individual’s life, in either parents, which requires a realignment, and it's not just mothers who need it but also fathers."Dr Samir Parikh
'Paternal Mental Health is Just as Important'
“Paternal mental health is just as important as maternal mental health for the child’s development and future risk of Psychiatric illnesses,” says Dr Syeda.
“This is something that doesn't get a lot of thought, especially in a country like India where fathers are kind of just removed from the whole child care scenario. That is not something that is positive as far as the mental health of the family unit is concerned.”Dr Ruksheda Syeda
Although studies on PPD in men is limited, they point a link between unresolved depression in new fathers with a long-term disruption of the family's collective mental health. This can manifest as,
Increased emotional and behavioural problems in the child
Impact on child's attachment to the father
Impact on the emotional development and attachment in future relationships
Increased conflict in marital relationship
Causing or worsening depression in the mother
'Paternity leaves must be normalised'
“Paternity leave is definitely something we should make more normal than not," says Dr Syeda. "Because that would definitely be in the favour of mental health of not just the father, the parent unit as a whole and even the children.”
When it comes to treatment, as both Dr Syeda and Dr Parikh said, the course of action may include a combination of medication and psychotherapy (depending on the stage) like any other depression.
But the key to getting help is recognising the problem and acknowledging that you need help.
“Just as a mother is told don’t eat this, don’t eat that, it's not good for the baby, we also need to kind of tell the father take care of yourself, it's not good for the baby," she adds.