Dr. Blumenfield explores the lesser known forms of pre- and post-partum depression
This article originally appeared on PsychiatryTalk.
A 46-year-old man was in psychotherapy with me for one-and-a-half years. He originally came for treatment after his boss told him that he wasn’t aggressive enough with his management style. He did not have a psychiatric history or evidence of depression or other symptoms. He worked well in treatment around his interpersonal relationships that were related to his childhood family dynamics. He had a good marriage and shared many interests with his wife. They had one two-year-old son. His family history was positive for mental illness in that his maternal uncle had a bipolar disorder. The patient was pleased that his wife became pregnant, but 6 weeks after the birth of his daughter, he became increasingly depressed for no apparent reason. He had periods of sadness, tension headaches, and the loss of excitement that he had about his new child. His wife was handling things well, but his depression progressed to point where he had insomnia and decreased appetite. He began to worry that he would not be able to provide for his family. The patient was put on Sertraline 50mg/day, and the dosage was titrated up to 125mg/day. His depression went into remission within 6-8 weeks, and he began to do well in all phases of his home and work life. He did have some mild sexual side effects, and the medication was discontinued after 4 months. The patient was doing well at one-year follow-up.
Research Identifies Paternal Depression
, which looked at 43 studies involving 28,004 participant studies which took place over the past 30 years. They used modern approved statistical methods and found that prenatal and postpartum depression was present in 10% of the subjects studied and that this was statistically significant.
Depression in women related to pregnancy is a well-known phenomenon with an incidence rate of 10-30%. Most clinicians do not usually consider the possibility of depression in men related to the partner’s pregnancy. A meta analysis was published in a recent issue of the
Closer Look at The Data
The one year prevalence rate in men for depression would be expected to be 4.8% whereas the paternal depression rate between the first trimester and one year post partum was 10.1%. When the results were analyzed by location, the paternal depression in the United States was 14.1% compared to 8.2% internationally. In regard to timing, fathers experienced the highest rate of depression 3-6 months post partum although there were not enough studies that made this distinction to make conclusions that were statistically significant. The research data was not able to draw any conclusions about trends distinguishing prediction of severe depression from minor depression. The correlation between between paternal and maternal depression was positive and moderate in size. It has been shown that marital satisfaction in women is a close correlation of depression and is among the strongest predictors of maternal depression. However while the data showed some association between materal and paternal depression it was not established as a causal influence.
Maternal depression may be related to changing hormone levels and/or well known psychological factors related to the mother child bond and /or related to sleep deprivation as well as the impact of the long, difficult at times child care. It seems unlikely that hormonal levels are a key factor with men ( although I wouldn’t rule out the power of certain mind-body mechanisms, especially through the pituitary-adrenal axis ) until research studies are done. There obviously is a great deal of psychological meaning to men about becoming a father. Most fathers will take pride in producing a child and achieving this role but to some there may be concerns about no longer being young and free of responsibilities. The financial obligations of being a parent can be a burden on some men (as well as on some women). All of these issues can trigger feeling of loss and depression. The modern man more than his father is likely to be sharing in some child care responsibilities. This can mean getting up at night to give the baby a bottle and change the diaper with the potential of sleep deprivation as well as frustration by infants who are not easily soothed. Finally pre-existing conditions of depression or bipolar disorders can be present in both men and women and can be exacerbated by a major life event such as a pregnancy.
Prenatal and Postpartum Screening for Depression Should Not be Limited to Women
Good prenatal and postpartum care of women should include some type of screening for depression. This may be in the form of a brief questionnaire or in the form of a distinct assessment by the clinician who sees the patient. Both methods may be used. This should be repeated periodically in follow-up visits. One needs to be particularly diligent if there is a previous history of depression or bipolar disorder.Now that there is data to support the concept that men can have depression related to pregnancy and childbirth, every effort should be made to extend the screening net to include the fathers. The easiest method would be to add screening questions to any written or verbal questionnaires that are utilized and include an appropriate question in the interpersonal examination by the clinician. It would also be a good idea for the clinician to invite the father in for a brief chat when he is available and even suggest that he should make an effort to be present for some of pre and postnatal visits.