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After the birth of a child, both men and women are susceptible. How to respond
The birth of John Hyman's first child didn't fill him with the joy he might have hoped for. Far from treasuring every minute with his son, the Rockville, Md., college writing instructor reacted by teaching more courses just to get himself out of the house. "I didn't know what my role was there," recalls Hyman, 51. His wife, by contrast, bonded instantly with their son, Jake, now a teenager. "Betsy fell in love. It was primal," he says. "I didn't have that experience. I thought I was broken. I remember thinking this was a dirty little secret I would have to deal with."
Hyman wasn't broken. He was depressed. Long recognized as a problem afflicting some new mothers, postpartum depression can also grip men—though mental health professionals acknowledge that until recently they largely overlooked that fact. Male postpartum depression took a step out of obscurity this month when it was for the first time the subject of a workshop at the annual meeting of the American Psychiatric Association.
 Ten percent of new fathers and 14 percent of new mothers are affected by depression, says psychologist James F. Paulson, assistant professor of pediatrics at Eastern Virginia Medical School in Norfolk, Va. Yet most men and their partners fail to recognize the condition when it arises. The symptoms are similar in both sexes, but the causes may be different. Hormonal changes can contribute to a woman's suffering, experts suspect, whereas sudden and unexpected lifestyle changes are thought to trigger a father's depression. "After the baby is born, there's a change in family structure," says Thomas Newmark, chief of psychiatry at Cooper University Hospital in Camden, N.J., and organizer of the APA workshop. "There might be pressure to take care of the child economically. The man may not get the attention from his wife that he was used to. And, of course, his sleep is affected."
Depressed dads are more likely than moms to display destructive behaviors, including increased use of alcohol or drugs, shows of anger, engagement in conflicts, and risk-taking such as reckless driving or extramarital sex. Some, like Hyman, elect to work longer hours. Other signs: a depressed or sad mood, loss of interest or pleasure, weight gain or loss, oversleeping or trouble sleeping, restlessness, fatigue, feelings of worthlessness or guilt, impaired concentration, and thoughts of suicide or death. The depression can begin within days or weeks of delivery and last for a year or more.
 If untreated, a father's postpartum depression can be harmful to the child as well as to both parents. Children born into such families receive less attention from the depressed parent and are at increased risk for developing physical and emotional problems, Paulson says. Depression in the father is thought to increase the likelihood that his children will act out or behave destructively. (Depression in the mother, by contrast, is associated with decreased overall health, learning problems, and a greater risk for developing depression.) Postpartum depression can typically be treated with therapy, medication, or a combination.
A partner's involvement is usually critical to identifying depression in a new father. "Often times, it will be the wife who is first to notice," says Berkeley, Calif., psychotherapist Will Courtenay, who specializes in men's health. "She'll say, 'He just hasn't been himself lately.' "
Vigilance is most called for when one's partner has been previously depressed. Having a history of depression or mental illness puts a father at greater risk of postpartum depression, as does having a spouse with postpartum depression. This is true even if the couple is separated, divorced, or unmarried, says Paulson, whose Eastern Virginia team earlier this year completed a study, now under peer review, involving noncohabitating parents.
Hyman, who didn't undergo treatment, experienced a turning point two months after his son's birth, when his wife placed the squirming infant on his chest and father and son fell asleep. "When I came to, I looked down and just collapsed into tears," he says. "I knew then that he was a part of me."
7 Steps to Stop Postpartum Depression Before It Starts
 By Dana Scarton, U.S. News & World Report
Posted May 21, 2008
Familiarity with the signs of depression and advanced preparation for changes that accompany the birth of a baby may help prevent postpartum depression, which experts now realize affects men as well as women. Mental health professionals recommend:
- Attending hospital-sponsored parenting classes.
- Designing a financial plan to address expected baby-related expenses.
- Devising strategies for shared childcare responsibilities. The father, for example, may handle a nighttime feeding by using formula or pumped breast milk.
- Addressing marital or relationship issues before the child is born.
- Hiring domestic help or asking a family member to baby-sit once a week.
- Understanding that sex lives change with the birth and may not return to normal for a year or more.
- Joining a support group for new fathers or reading about depression on websites such as PostpartumMen.com, which includes a screening test for men.
Depression
(Major Depressive Disorder)
SYMPTOMS
 A person who suffers from a major depressive disorder (sometimes also referred to as clinical depression or major depression) must either have a depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period. This mood must represent a change from the person's normal mood. Social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. For instance, a person who has missed work or school because of their depression, or has stopped attending classes altogether or attending usual social engagements.
A depressed mood caused by substances (such as drugs, alcohol, medications) is not considered a major depressive disorder, nor is one which is caused by a general medical condition. Major depressive disorder generally cannot be diagnosed if a person has a history of manic, hypomanic, or mixed episodes (e.g., a bipolar disorder) or if the depressed mood is better accounted for by schizoaffective disorder and is not superimposed on schizophrenia, a delusion or psychotic disorder. Typically the diagnosis of major depression is also not made if the person is grieving over a significant loss in their lives (see note on bereavement below).
Clinical depression is characterized by the presence of the majority of these symptoms:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterized as an irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
In addition, for a diagnosis of major depression to be made, the symptoms must not be better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
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