Six years ago, Craig Mullins was working toward his master's degree in counseling when he became a dad, but he still did not recognize his own symptoms of depression until they dissipated, a year-and-a-half after his baby girl was born.
"She was our first child, and I was so excited... but my expectations of fatherhood did not match the realities of fatherhood," Mullins told The Huffington Post. His daughter was colicky, and cried inconsolably for hours at a time. Mullins and his wife started to began arguing with an intensity that was new and unnerving.
"It was a really dark time, and I felt pretty hopeless. I felt like I was in over my head," said Mullins, who now specializes in the treatment of paternal postpartum depression in his Colorado practice. "I was absolutely depressed, and for me that manifested itself in terms of irritability, impulsivity and feeling unable to find pleasure in anything."
Postpartum depression is widely perceived as a woman's issue, a belief reinforced everywhere from medical sites that define it as an issue facing new "moms" and "women," to Internet commenters who assert, "there is no such thing as PPD for dads."
But whether it goes by the name paternal postpartum depression, paternal depression in the postpartum period or something else, estimates suggest depression in dads is, in fact, a relatively common phenomenon -- affecting anywhere between 4 and 10 percent of them during their partner's pregnancy or in the first year postpartum. And it can take a serious toll on men's wellbeing, as well as their children's.
"I think maybe it's still hard for people to understand that men can get postpartum depression because they don't understand the underlying risk factors," said Katherine Stone, founder ofPostpartum Progress, a blog and non-profit. "It may be hard to understand from the standpoint of, 'Well, if you didn't have the baby, how can you have it?'"
Although rates of postpartum depression are indeed higher in women -- anywhere between9 and 19 percent -- "you don't have to have two X chromosomes to suffer from depression and anxiety," said Stone, adding that a widespread misperception about postpartum depression is that it is caused solely by a woman's fluctuating hormones. While changes in hormones like estrogen and progesterone, are indeed a contributing factor for many women, non-hormonal factors, such as sleep deprivation and stress can also play a significant role. And some preliminary research has even suggested that fathers undergo their own hormonal changes, though whether they have specific implications for the development of depression is not yet clear.
"For me, I really [chalk] it up to stress -- financial stress, the stress of being uncertain of how to care for a baby," Mullins said. "Anything that puts a lot of stress on someone for an extended amount of time, well, you can only bear it for so long."
New fathers' depression may go unrecognized in part because knowledge of the problem is relatively limited, but it may also be because men may show different signs of depression, Mullins said. He personally did not cry a lot -- a commonly cited symptom. Instead, he felt "pissed off" and angry. Many of the men he treats turn to substances or avoidance, retreating into work or pornography -- behaviors that may not be picked up on by themselves or others around them.
"I've seen guys turn into 'Call of Duty' addicts, because they feel like they're really good at it, unlike parenting, and it's fun," Mullins said. "It's a chance to veg out and ignore what's going on." Most women have a six week postpartum check-up where healthcare providers are supposed to discuss postpartum depression (though it is not clear how much that actually happens). With no one asking after their mental health, new dads can fall through the cracks.
But research clearly demonstrates that it is important for men to get treated for depression in the postpartum period, for many of the same reasons why it is vital that women get help. For example, a recent study found that found postpartum depression in men affects their behavior and level of engagement, which is, in turn, linked to anxiety and behavioral issues in toddlers.
"A father's mood does influence how they interact," said Sheehan Fisher, a co-author on the study and instructor of psychiatry and behavioral sciences at Northwestern's Feinberg School of Medicine. "And how they parent is affected by their mood, similar to how a mother parents is affected by her mood."
Fisher generally uses the same definition for postpartum depression in men and women ("it's the same terminology, because we're looking at depression in a particular time period," he said), and believes the important issue is continuing to learn how depression affects new fathers, as well as their families. "That's not going to detract [from research focusing on women], but actually build on it, so we get a better idea of what's going on," he said.
Talking more about the issue, Stone echoed, is a good thing.
"It's not silencing the voices of women and what they go through," she said. "It's just adding to the conversation in terms of what dads may experience."