Male Postpartum Depression (Yes — MALE!)

He was an urban youth.  I could not even determine his racial origin and I had to ask him (county regulations – tracking who it paid for – not my choice). It was mixed, and essentially indeterminate, a regular American melting-pot.

His head was shaved, so I could not make any guesses on the basis of hair type. There were facial tattoos, of the tribal sort, lots of triangles, but nothing as fiercely antisocial as some of the obscene drawings or sayings I had seen tattooed on prison inmates faces.  Or in the case before me – ex-cons. And there was one of those little cylinders in his earlobe –the kind that men wear to stretch the open hole in their earlobes large enough to allow passage by a small sparrow.  I believe the tradition is for tribal identity to prove something about achievement in the face of pain.  It differs according to whom you ask, and this young man was not ripe for asking about that topic.

“I’m depressed.  Real depressed.”

I wanted to know why.  “I got kids.  Seven of them, three different states.  The seventh one was born three days ago.  I was with the Mommy, and we were really happy because he looks just like me.”

Quite an achievement for someone only 22 years old. However, my congratulations did not bring him solace. “I guess you aren’t feeling too great about it, though, or else you wouldn’t be here, feeling depressed.”

At least he wasn’t suicidal.  I could treat him as an outpatient.

This was one of those situations I found myself in where medications were the only thing available, none of that natural alternative stuff.  However there were lots of pharmaceutical choices on my available formulary that could help.  I might also be able to recommend some therapy.  But I would have to know more.

Basically, he told me a story of restraining orders that kept him from seeing his children, as did his inability to make any kind of child support payments on anybody. He hadn’t had much schooling, but a little time in jail had made him wise enough to cease his past profession — drug dealer.  He had enjoyed some success in this profession, apparently because of a natural talent for marketing.  Had he not been so talented, I might have convinced him to try business school at one of the local junior colleges.

But who could find his natural talents now? I had heard of proud and demanding “baby-daddies,” but not a guy like this. There is precious little literature on this phenomenon, but I really think that our notion of sexual equality has extended itself to if not the creation, at least the recognition of male post-partum depression.

So a therapist has a website about this.  Maybe marketing; maybe working through his own post-partum depression.

So this is a widespread phenomenon.  And culturally, being a member of some kind of urban youth subculture was no help.

Enter the February 2010 Psychiatric Times, which they send to shrinks in hard copy, and its only article which I could not find reproduced online.  The author, James F.Paulson, PhD, has shown up on MedicineNet with the same concept.

As many as one in ten of new dads can be hit with this.  They become less likely to interact with children, to read to them, and to do “daddy” things.

Men live depression in different ways than women; they become aggressive, withdrawn, and the like.  Whatever.  They become less likely to interact with young children, clearly, and they give the children less ability to relate to a fatherly role model.

I offered the patient in front of me a conventional antidepressant and he seemed happy to take it.  Blood work; medical assessment, all of the usual things.  Psychotherapy consult? Who knows what that means in this day and age.  I started with a “social aide” type.  I had no idea if this young man could (or should) have access to his other children. After all, few people tell the truth spontaneously in situations where this much shame is involved.  It was actually amazing that this young man had told me as much as he had. I explained a little about therapy.  The patient agreed with what I had intuitively felt.  Let’s hold off on that until we know factually what he can or cannot do.

I told him he was young and had skills (as proven by what he described as more than average success at selling drugs.  I mean, come on, this is no time for moral judgment).  I suggested work or school or both.

Suddenly, there was a little bit of light in his eyes.  He could become a provider for his children, and he liked that.

I am a longtime supporter of work-study programs.  I did one in college — brought in money to help with tuition by doing first, library cataloguing and then, emergency room work.  The lessons I learned stood with me.

We would help him find programs.  We would treat his depression.  He was glad he had come in.  We had somehow bonded with him, and this is good.

The question of “why?” remains.  Some of us go to the biological obvious, even the tautological.  This male postpartum depression may be playing an evolutionary role.  It is one of a few forces that seems to make a father want to stay around and be protective of a mother bearing his child.  Hooray.

Some of the reason may be poor diet, the drug exposure of the past. Psychosocially, the reason may have something to do with guilt, something which the legal system seems to have liberally heaped on to this young man. One more phenomenon to think of, find, and treat.

This young man was genuinely suffering.  The depression is not, as none are, in any way “good” or merited or punishment.  Depression is horrific and needs to be treated without prejudice.

I will not deny that looking past the facial tattoos and ear spreaders was not easy for me.  But I am proud that I did it.  I am proud that I lived up to my own ideal of being a non-prejudicial provider of services.  For my reward, in being that, has been learning something new about the human condition; something I can apply to treating more people in other places.