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Postpartum depression: Not just a concern for mothers
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June is Men’s Health Month, an annual commemoration intended “to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys,” according to MensHealthMonth.org.
In recognition of this event, throughout the month, Healio Family Medicine will highlight a specific health condition and its impact on men. Last week our series began with heart disease, the leading cause of death in men, according to the CDC. This week we take a closer look at a condition often overlooked in the male population — postpartum depression.
“The postpartum period for dad of a child less than 1 year old, especially when it’s their first child, needs special attention,” Rebecca Cipriano, MD, of the Jersey Shore University Medical Center in Neptune, New Jersey, said in an interview. “Obstetrics and gynecologic practitioners are required to screen new moms for depression, but for their partners, it’s up to primary care physicians to be on the lookout for postpartum depression.”
The prevalence of the condition remains uncertain, with one expert saying it occurs in 5% to 10% of dads, and another saying it occurs in as many as 25% of all fathers.
Healio Family Medicine asked Cipriano and Maria Muzik, MD, MS, associate professor of psychiatry at the University of Michigan, for ways that PCPs can identify and treat postpartum depression in men, discuss the subject with their patients and more. – by Janel Miller
Healio: How can PCPs broach a subject like postpartum depression with their male patients?
Cipriano: It takes time for men to realize they are having a problem with depression — and many do not feel comfortable with the subject and rationalize it away as unimportant or weak. At times, a simple question exploring if the patient has anything else they would like to talk about will uncover something like postpartum depression and lead to a proper referral for help. PCPs should stress to their male patients that the desire to be perfect parents and raise perfect children is unrealistic. Their wanting to be a good parent allows them to recognize being a parent is hard and there will always be uncertainty. These patients need to be told it is normal to have problems.
Healio: What are some of the common risk factors for postpartum depression in men?
Cipriano: Statistics show that these are some of the factors that may increase the probability of postpartum depression: difficulty sleeping and poor sleep over a prolonged period; history of emotional instability, and or depression or anxiety; conflict with the spouse, parents, or in-laws.
Muzik: Other risk factors, that are relevant for mothers but also fathers for developing postpartum depression include the presence of psychosocial risks such as living in poverty or unsafe neighborhoods, experiencing lack of social support, or having to care for a child with special needs. Men who feel overwhelmed by their fear of having enough physical, mental or financial capacity to be a successful father and care for their family are also at risk for postpartum depression.
Healio: What are some of the symptoms that men with postpartum depression may display?
Muzik: Men with postpartum depression may display more pronounced emotional liability and be easily irritated, frustrated or impatient, and appear easily angered. They may engage in conflicts at work or with their friends that are otherwise not typical for them, or they may stay at work for longer hours than usual since they are worried about productivity and providing for the family. Physical symptoms can include headaches, pain syndromes and frequent tiredness.
Cipriano: Other possible symptoms include difficulty laughing or being humorless; lacking feelings of enjoyment; excessive worrying; feelings of being overwhelmed; difficulty sleeping; feeling down in mood, crying, or irritability; considering self-harm; and excessive conflict in the relationship.
Healio: Is there anything the mother of the child can do to help prevent postpartum depression in their male partners?
Cipriano: In my practice I find new moms are saying their husbands are “No Help” with the baby. I usually ask them to give their partners specific tasks with the baby that they can master. For example, if the male parent knows he oversees bath and bedtime, he gets good at this task, feels useful and mom knows this is her break time and is reassured that her partner is helping.
Healio: What are some treatment options for postpartum depression?
Cipriano: Sessions with a psychiatrist, psychologist or social worker who will assist to resolve emotional difficulties are highly recommended. Some specialize in postpartum disorders in both sexes and you should see if such a medical professional exists in your community. If a physician practices in a rural setting, they may want to refer patients to websites and forums dedicated to this topic, such as PostpartumMen.
Muzik: First-line of treatment should be counseling or complementary and alternative in nature. Research has shown that omega 3-fatty acids and vitamin D are helpful in treating postpartum depression in women, as is exercise and light therapy, and thus similar strategies can be explored as treatment options in men. If these options fail or the condition is too severe from the start, antidepressants should be considered for men with postpartum depression.
Healio: What are some nonpharmacological and psychological approaches to prevent postpartum depression?
Muzik: PCPs need to create an environment that is welcoming to both parents. This can be as simple as including pictures of dads with the new baby that many OB/GYNs hang on their wall or facing the dad during appointments so that they don’t feel invisible. As medical providers, we must recognize that pregnancy and follow-up visits after the baby is born are family matters, not just mother and child matters. You must bring men into the postpartum conversation and make him feel welcome in the office. Ask the father how he is doing when he comes along, and if he doesn’t come, ask the mom if he wants to come along next time so that he feels more engaged.
Healio: Why is it so important to address postpartum depression promptly?
Cipriano: To disregard major factors that are interfering with normal life functioning is dangerous. Unresolved conflict will only get worse.
Muzik : Parenting is hard enough as is. Being depressed and caring for a baby is even harder, for moms and dads alike. Research shows that the first 1,000 days of a child’s life are critical for the child’s brain development, and that positive relationships with nurturing parents are the most important ingredients for lifelong health. We need to make sure we are doing everything we can to help parents do the best job they can.
Disclosures: Neither Cipriano nor Muzik report any relevant financial disclosures.