Postpartum Depression Is Coming for Fathers

  Two years ago, when we brought our daughter home from the hospital, my husband, Byron, stopped sleeping. Even months after the baby started sleeping through the night, he lay awake for hours at 2 a.m., unable to drift off. I’d always known him as upbeat and unflappable, the type of person who goes on a post-office run to mail a single letter. Now, for days in a row, he couldn’t make himself shower or leave our apartment. We’d aspired to be equal caregivers from day one. We split the duties as evenly as we could: We each got out of bed to stick milk into our daughter’s mouth, bounced her on a yoga ball during her ten hours of daily naps, and frantically brainstormed what to do each evening when the clock struck 5 p.m. and she began inconsolably screaming. Caring for my child, I felt like I was becoming more myself than ever — more confident, more productive, more patient. Byron did his share without complaint. But after his shifts, he’d retreat to bed, alone, where he’d spend hours reading Reddit posts about other people’s legal problems and updates on various wars. I couldn’t understand what was wrong with him. I was the one who was bleeding onto the sofa and breastfeeding ten hours a day. I begged him to do the things that might help him feel better — working out, seeing friends, holding our daughter against his bare chest — but he wrote them off as futile and said, “I’ll feel better when she starts to talk.” Our different feelings about our baby put a wedge between us. She was the love of my life; I wanted seven of her. Meanwhile, he stopped speaking, as though he feared that, upon opening his mouth, he’d say, “I think I’ve made a terrible mistake.” Once, as he held our child, I realized he couldn’t bring himself to say “I love you” to her. Had he ever said it, I wondered? Secretly, I worried he just didn’t love her enough. While I was screened repeatedly for postpartum depression, no one asked Byron how he was doing. One day, as I complained to my therapist about Byron’s insomnia, she said, “He’s depressed.” At first, I wrote it off: I thought his low mood came from his bad sleep, never considering that they shared a common cause.  But when I started talking to friends about what was happening to Byron, I found that he was far from alone, especially among a younger, more hands-on generation of fathers. In May, the clinical psychologist and parenting influencer Dr. Becky invited a father onto her show who discussed his experience with what researchers call “paternal postpartum depression,” a phenomenon experienced by an estimated one in ten fathers of newborns and up to 25 percent of men with a 3- to 6-month-old baby. “I would go far enough away that no one would notice,” Kevin Maguire said, “and I would cry because I didn’t love my son.” In the comments section, hundreds of angry mothers attacked him and other fathers who chimed in with similar experiences. “Postpartum depression can’t ‘present in men differently’ because men cannot be postpartum,” one of the top Instagram comments reads. Another reads, “Please, don’t conflate the horrible hormonal shift that birthing mothers deal with with the feelings you had separately.” To many women, applying the term “postpartum” to men erases the challenges of pregnancy and birth; mothers still do most of the work while fathers consistently overestimate their contributions. Another Instagram commenter said the difference between female PPD and male PPD was like the difference between having cancer and being a cancer patient’s support person. Until a decade ago, there was almost no research into men’s transition into fatherhood. “Historically, men’s identity didn’t have to shift as much,” said Sheehan Fisher, professor of psychiatry and behavioral sciences at Northwestern University School of Medicine. “They are going through a phase their own fathers didn’t go through.” Darby Saxbe, a professor of psychology at the University of Southern California who runs a respected lab studying new fathers’ brains and hormones, said, “As men are becoming more involved in parenting, they’re experiencing a lot of the same risks moms have been going through.” Saxbe’s new book, Dad Brain, outlines how involved fathers undergo many of the neurological, hormonal, and social changes we associate with motherhood. Paternal mental-health crises are a by-product of the movement toward egalitarian parenting, but fully realizing that equality requires taking new fathers’ struggles seriously. Saxbe set up her lab at the University of Southern California in 2013. She wanted to study how parenthood changes the brain, and her first instinct was to do MRIs of pregnant women. When that posed safety concerns, she turned to fathers — and then became fascinated by them in their own right. She began following 100 couples expecting their first child. She gave the men MRI brain scans, tracked the hormones of both moms and dads, and collected longitudinal survey data. (The project is ongoing; she has nearly completed the seven-year follow-up.) Her initial paper, in collaboration with a lab in Spain, was the first comprehensive study of brain change in dads. The results shocked her: New fathers’ brains experience similar shifts to moms’ brains, including losing gray-matter volume in areas associated with executive functioning, visual processing, attention, and empathy — even though they’d never been pregnant, never given birth, and never breastfed. The men who spent more time with their infant and more time as primary caretaker experienced more changes. “They’re just spending time with a pregnant partner and a new baby. So the fact that you can see brain-structure changes that look similar to moms to me is kind of amazing,” Saxbe said. “If men are in fact showing plasticity, that tells us something really important about experience”: that the work of care can alter us almost as deeply as actually physically creating new life. Saxbe’s lab was part of a wave of research investigating the changes undergone by new fathers. Other studies suggested that new dads’ testosterone plummets; prolactin increases, explaining some of the 14 extra pounds fathers weigh on average compared to non-fathers. In one study, changes in patterns of brain activation suggested that even pictures of attractive women lose some of their allure while photos of cute babies become more enticing during men’s transition to fatherhood. The more men hold, feed, and bathe their infants, the more their brains and bodies change. And as the role of fathers becomes more hands-on, researchers think, these physiological changes are growing more pronounced. One study examined the experiences of gay men who’d become fathers via surrogacy; the primary-parent fathers exhibited brain changes that were a combination of those seen in secondary-parent fathers and primary-caregiver mothers. Another study even found that more nurturing fathers have smaller testicles. Since the field is so new and so small, these findings are preliminary, but they offer insight into the maelstrom of new fatherhood. These changes are adaptive: A father whose testosterone has dropped more tends to be a more attentive parent with less relationship conflict. But low T is also associated with decreased energy and motivation, fatigue, poor sleep, and bad moods, which are all hallmarks of depression. (Saxbe, for her part, stands by using the term postpartum depression — “it just means ‘after birth’” — although a more accurate term is “perinatal.”) While these physical changes are meaningful, Saxbe cautions against overmedicalizing the phenomenon and overlooking social and cultural forces. One predominant theory of postpartum disorders is called “evolutionary mismatch”: that trying to raise children in a nuclear family is so stressful and contrary to human nature that it drives people mad. Researchers estimate that hunter-gatherer societies often have more than ten caregivers for every young child. Saxbe writes about an Indigenous group in the Philippines where mothers and fathers, combined, do only one-third of the infant care. In the Democratic Republic of Congo, Efe infants are cared for by 14 alloparents per day and are passed between caregivers eight times an hour. As Americans have children later in life, grandparents may be too old to help; meanwhile, today’s parents tend to have fewer children and to space them much closer together in age, which makes it less likely older siblings can help. Many of the men in my social circle had never held a baby before their own. One theory, then, is that as dads become more involved, they’re exposed to the very mismatch that new mothers have experienced. One study of Swedish men showed their depression peaking at a year after birth, when moms tend to go back to work. For other dads, this peak occurs at three to six months, when parental leave is over for almost all parents.  A friend introduced me to 40-year-old Nathan. Before the birth of his first child in 2020, Nathan fantasized about what kind of father he’d be: He pictured rolling on the floor with his baby, deeply bonded. After his wife’s emergency C-section, Nathan felt powerless and shaken, but it was difficult to discuss with his wife, who hardly remembered the birth. His son only slept for 45 minutes at a time, and Nathan spent long nights bouncing him on a yoga ball until he threw out his back. Like Byron, he struggled to sleep, even when his wife was on duty. For weeks, he hardly ate, fought bone-deep exhaustion and “total brain fog,” and experienced constant memory lapses. He was eventually diagnosed with depression, ADHD, and an anxiety disorder. Sometimes it’s depression; other times it’s anxiety, obsessive-compulsive disorder, and even psychosis. Through another acquaintance, I met Josh, who, when he became a father at 35, began experiencing intrusive thoughts about hurting his son. “Every time I’d have to take him up or down the stairs, I would clench him with an iron grip,” he said. “Otherwise, there was something inside of me that was going to intentionally drop the child.” He loved his son, but he couldn’t turn off the obsessions. One afternoon, hanging posters in his son’s nursery, Josh couldn’t stop thinking, Beat him with the hammer. He hid his tools. “Before the baby, I wouldn’t be afraid to talk about anything with my wife,” he said. “I was afraid to talk about this.” Saxbe fears that her findings will be used to say that men shouldn’t be involved, that we should go back to the 1950s when mothers did everything. A huge body of evidence shows that everyone benefits from fathers being hands-on from the beginning, despite the challenges. “Moms have a big head start,” she acknowledges; fathers’ adaptations take time. Byron and I entered parenthood sharply aware of mothers’ gendered struggles, and we believed we could sidestep these pitfalls with a fervent dedication to fairness: two parents with identical roles, burdens, and emotions. We discussed in great detail what 50/50 would look like, even devising a schedule where we alternated our days of primary parenting as if we were divorced. We thought “equality” meant equal effort, equal time, and equal feelings toward our child. Only looking back did I realize that the plan derailed as soon as an embryo implanted. For me, gestation was as real as a car crash, starting with the exhaustion that inspired me to take a pregnancy test. By the second trimester, I felt like a parent: I’d learned to pee before leaving the house and always carry a snack. At the gym, I’d ask our “little one” for help, and my belly always seemed to respond. Still, when our daughter was born, I didn’t accept that she and I had a privileged relationship, even though we’d done everything together for nine months. When the midwife helped our daughter latch onto my breast, she felt like a stranger I’d known in a past life. When, an hour later, Byron placed our daughter on his chest, she was just a stranger to him. This situation might not have come as such a surprise if we’d held more traditional views about the roles of mothers and fathers. I used to debate with a friend who believed that mothers have a privileged, sacred bond with their infants, and babies need their moms — not their dads. After she gave birth, her husband took two days off; he seemed to experience zero turmoil and acted completely unchanged by his entry into fatherhood. In that first year, he changed less than five diapers. My friend didn’t seem distressed about a lack of bonding: They’d build a relationship later, she said, when their son was older and interested in math. For Byron, the differences in our experiences were glaring and inescapable. All our daughter wanted to do was nurse; meanwhile, Byron was stuck doing dishes and serving me snacks. If anything, the physical connection to my daughter buffered me through the nonstop evening screaming and the one-handed meals of trail mix and frozen breakfast burritos. Byron, however, was going through this while mourning the loss of his support person and social life (me). My bliss constantly reminded him of what he lacked. I had the tools to immediately comfort her. A sense of peace and well-being flooded over me each time she nursed. The men I interviewed echoed that the gulf between expectation and reality made them feel incompetent and sidelined, like bad fathers and bad men. Elyse Springer, a certified perinatal mental-health therapist focused on men and partners, says people often tell her perinatal mental health should be a “women’s-only space.” When she’s presented at conferences, hospitals, and nonprofits, she says the audience often reacts to the concept of paternal perinatal mental-health issues with skepticism or hostility. Clinicians have asked her, “Can’t women have just this one thing?,” to which she responded, “What are you wanting? Are you wanting all moms to be solo, single moms?” Fathers’ mental health has a similar impact to moms’. Depressed fathers are three times more likely to hit their 1-year-olds; 18-year-olds whose fathers were depressed, anxious, or experiencing elevated stress when they were babies are more likely to suffer from cognitive, Original Postii/S0890856709623947" shape="rect">emotional, and physical development problems. Pediatricians and obstetricians already screen mothers for PPD, and some experts want them to ask dads the same questions. “When you go into a clinic, everything from the intake to the pictures on the walls are geared toward women. The message to dads is, ‘This is not about you at all,’” Springer said. The men I spoke to seemed embarrassed about their struggles (none agreed to use their full names). Multiple told me, defensively, “It’s always harder for the mom.” Tova Walsh, associate professor of social work at the University of Wisconsin Madison, says fathers in her research often agree that “the focus should be on supporting Mom” and downplay their own experiences. Meanwhile, those same mothers tell Walsh that one of their biggest stressors is the father’s mental health. “No one’s checking in on him,” they tell Walsh, so the burden falls on them. Couples with a depressed partner are more likely to break up, potentially leaving women with the colossal task of becoming single moms. Many mothers, myself included, found managing their partner’s mental health the most stressful part of the postpartum period — far more grueling than caring for a baby. Cynically, if paternal mental-health problems become more widely recognized, there might be actual funding for research, and women will be the secondary beneficiaries, as we always seem to be. Men across the political spectrum now overwhelmingly want to be fathers, but the support often isn’t there. So many mothers sent me Google docs with their advice that I couldn’t read them all; near strangers gave me their phone numbers and told me, “Text anytime.” Not one person made the same offer to Byron. When he felt isolated, we looked for a postpartum group like the one I had, but we came up with nothing. I felt acutely his lack of network: The average 30-year-old American man has two emotional supporters, and often one is his female partner. Fifteen percent of men reported having no close friends. My husband went to half a dozen therapy sessions but was discouraged by his psychologist’s lack of perinatal training. Josh’s therapist told him he’d deal with the voices for the rest of his life — an assessment that appalled Springer. “It sounds like that could be postpartum OCD,” she said. “There’s effective treatment.”   Just as I’d lain prone on the sofa during my first trimester as my body reconfigured, now, in the months after our daughter was born, the same thing was happening to Byron. Of course he wouldn’t just do the things that made him feel better: That was the whole cycle of depression. I realized how mean I’d been to him about it, believing that his slower bonding came from a lack of care. “Love is a verb,” I had to remind myself. And he loved our daughter so much, as evidenced by the hours he spent bouncing on a yoga ball in her blacked-out nursery while wearing noise-canceling headphones. Regardless of how Byron felt, he was there. My commitment to equality meant that I had to take his experience just as seriously as I took my own. I couldn’t expect him to put in all the work and not feel anything about it. Over time, the men I talked to found ways to feel better. Josh worked on coping skills to manage his obsession. Nathan started taking medication that gave him an instant boost of energy; sleep training transformed their lives in three days. Before his second child, he logged hours in the gym, preparing mentally and physically for the challenge ahead. When my daughter was 4 months old, I injured my shoulder, and Byron became the de facto baby carrier. Suddenly, he had an important, irreplaceable role, doing an activity shown to help kids bond. His best friend had a baby six months after us. The two of them took walks with their sleeping babies strapped to their chests, basking in the adoration of onlookers. Eight months in, our daughter started signing; just after she turned 1, we understood her word: “egg.” Now that she’s a toddler with huge emotions, Byron and I joke about how he’ll be the better parent during the grueling teenage years — an idea that’s supported by Saxbe. This week, our daughter announced that, when she grows up, she wants to be a dada. This story was supported by the Rosalynn Carter Mental Health Journalism Fellowship.