When I started working on this site I, somewhat naively, thought that it would be greeted with open arms as a positive offering to men who are struggling with depression after becoming a new dad. But, as with anything in this life, things are a little more complicated…

For reasons that will become apparent, the first draft of this article was a ranting, passive-aggressive self-justification piece aimed at one particular misinformed fellow who implied that I was out to “mislead” men. It wasn’t fit for publication. It did however set the scene for addressing some of the misconceptions and myths which surround the phenomenon of Male post-natal (or post-partum) depression. I hope you like it.

The story began when my wife sent me a text saying that Male post-natal depression was going to be a topic on The Wright Stuff show. Optimistically and without thinking about it too much, I sent a tweet to the show suggesting that they check out the site:

This was the first response…

“Misleading men?” (Note: This is where the first draft of the article explored in depth the anger and other unpleasant emotions that I experienced in relation to our tweeter’s over-confident assertion that I am out to mislead. Whilst it would have made a good academic paper for a psychodynamic therapy training course, it definitely wouldn’t do much to further the cause of Male PND, so I’ll spare you the details (and expletives)).

I read on…

This is one of the first things that we hear people say when they compare female PND to male – “Isn’t it caused by hormones, and if men arent’t actually carrying the baby, then how could it apply to them?” Except, only 10% to 15% of women develop post-natal depression. If hormonal changes were the cause of PND, and all women experience the same hormonal changes, then we would expect all women to develop PND. They don’t. Therefore, it is widely accepted that there are other factors involved.

The following list (accredited to Beyond Blue) details many, but not all, of the other factors which can contribute to the development of post-natal depression. As we can see, many of these factors can effect men as well as women – no biochemical changes necessary!

• Personal or family history of mental health problems or current mental health problems
• Pregnancy, labour or delivery complications
• Perinatal loss, e.g., miscarriage, stillbirth or termination
• Current or past history of physical, psychological, or sexual abuse
• Anxious or perfectionist personality
• Lack of support from family and friends
• Stressful life events (e.g., moving house)
• Continuing lack of sleep or rest
• Unplanned pregnancy
• Having multiples (e.g. twins or triplets)
• Severe baby blues after the birth
• Premature baby
• Difficulties with breastfeeding
• A baby that is difficult to settle
• Partner experiencing perinatal depression or anxiety

So, to really labour my point, and with reference to the original tweet – Post Natal Depression isn’t something that just “effects women biochemically.” This is an unhelpful myth that perpetuates the notion that depression is all in the head, rather than it being the consequence of multiple interacting biological, psychological and social factors, many of which can be acted upon (with appropriate support) to reduce distress.

I’m sorry that our tweeter feels that men will be ridiculed for “latching on” to a biochemical explanation for their depression symptoms. I don’t know if it’s true that men will be ridiculed or not, but there is evidence to suggest that men do also experience changes in hormones throughout the pregnancy and post-natal period. Testosterone, Oestrogen, Cortisol, Vasopressin and Prolactin have all been identified as being hormones which change in Men during the period, and changes in each have all been suggested to underlie a part the experience of Post-natal depression symptoms in men. Personally, I’m not the worlds biggest advocate of a purely biochemical (sometimes called the bio-medical model) explanation for depression, instead believing it be an interplay between biopsychosocial factors, but with reference to the tweeters concerns about ridicule, if someone has a physical issue which is beyond their control (i.e., hormonal changes) then surely they are less likely to be ridiculed for something than if it was something that was potentially within their control (i.e., a skill deficit or difficulty coping). Just my view.

Next…

I’ve heard this one before too.

Except, the UK guidelines for the treatment of Post-natal Depression and for the treatment of Depression are essentially the same. Here are the NICE guidelines for the treatment of post-natal depression:

We can see here that psychological treatment (CBT or IPT) is the preferred treatment for Post-Natal Depression in women. Antidepressant medication is considered secondarily.

And here are the NICE treatment guidelines for depression:

We can see that psychological therapies are the preferred treatment, with medication being considered in more severe cases. The treatment for both is the same.

If I was to treat a woman for post-natal depression with CBT, I would be looking to identify patterns of avoidance and reduced activity and support her to modify these. I would teach her how to problem solve current and potential stressors and I would also be interested in understanding how she thinks about herself and her situation, support her to re-evaluate unhelpful thought content and disrupt unhelpful thinking processes such as worry and rumination. But if I was treating a man… Guess what? I would do exactly the same. There may be differences in context and content (just as there are between all individuals who enter therapy) but the actual treatment would be the same.

There is also a good point to be made here to further challenge the biochemical explanation for PND mentioned earlier. NICE recommends psychotherapies as the preferred treatment for depression and post-natal depression, before the introduction of antidepressant medication. This is based upon multiple studies which show that CBT or IPT perform just as well as, or better than, antidepressants in research trials on depression treatment, with fewer side effects. Now, when a therapist sits down with a client, they don’t say, “right, let’s get your hormonal imbalance sorted out.” They instead say, “what would you like to change?” meaning, “how can we change things about you, your relationships, your environment, etc to get you feeling better?” We don’t treat hormones, we treat people. Leaning too much upon a purely biochemical model can leave individuals feeling passive, hopeless and resigned to their sadness, rather than empowering them to take even the smallest action to remedy their situation. Taking action leads to change and the opportunity for recovery.

I’m sure there are many more myths and beliefs that people hold about Male Post-Natal depression and I’m happy to tackle them all if it means that more men will be prepared to get help when they need to. Keep ’em coming.

 

Disclaimer: Depression in New Dads takes no liability for consequences of using materials on this site. In the event of crisis, a suitably trained mental health practitioner should be consulted.