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Interviewer: You've likely heard of postpartum depression in regards to the mother of a new baby. But did you know as many as 10% of fathers face their own sort of postpartum depression? And it can happen before or after their child is born. But unfortunately, men are unlikely to discuss it or get support. And untreated, it can impact the emotional health of the father and his ability to be available for his baby and the mother.

Jamie Lea Hales is a licensed clinical social worker, and she specializes in helping couples with their mental health during and after pregnancy. I didn't know postpartum depression was a thing that men could have. Does it have a particular name when men have it, or is it just male postpartum depression?

Jamie: Actually, it really doesn't have its own special name. You would think that it might, but the reality is we just refer to it as perinatal mood and anxiety disorders because it can hit moms, dads, partners, grandparents, and caregivers really just in general. So it's much more broad than I think we initially realized.

Interviewer: And what causes it?

Jamie: I think it comes from a combination of life stressors, changes, loss of identity, and also the fact that your brain can change as you become a parent.

Interviewer: Wow, that's really interesting. So is it all in the brain? Is it all chemical related or are there other factors that can contribute to male postpartum depression?

Jamie: Outside of the changes to the brain, realistically when you have a new baby enter your life, whether it's your first or your fifth, there are going to be some compounding psychosocial stressors that come along with that. It is one of the biggest changes that you can go through.

Interviewer: And what kind of stressors are the most common to contributing to perinatal mood disorders or postpartum depression in men?

Jamie: First and foremost, lack of sleep. I cannot hit that one enough because it is the thing that I see over and over again. If you are not taking care of yourself, if you're not getting enough rest . . . And when I mean enough rest, I mean four- to five-hour chunks at a time. For both parents, this is probably the key to keeping yourself well.

Interviewer: Are there other types of stress guys talk about that can lead to male postpartum depression?

Jamie: When we look at some of our male patients, the pressure to provide financially can actually increase stress quite a bit because there are dueling priorities between being home, helping out, and being more involved, which we are seeing a lot more men being more actively involved in their child's caregiving, but also the dual pressure of having to be at work as well.

I mean, I don't want to completely gender that because that can 100% be the reverse as well. But it's just a lot.

Interviewer: And I've heard another major form of stress for men can be these expectations about what it's like to be a father or the kind of father they want to be. Can you tell me more about that?

Jamie: We all have this idea maybe in our heads of what parenting is supposed to be or should be. And when you actually get into the thick of it, a lot of the time, it doesn't line up with exactly what you thought it would be. And so there can be kind of an interesting grief reaction.

If you had a difficult relationship with your parent, you may have a lot of pressure on yourself to do better than they did. Or if you feel like you had the ideal parenting situation and it's not . . . And some people do. I mean, some people really do feel like, "My dad was the best. He was the best that I could possibly hope for." And then when they feel like they're not living up to what those expectations might be, that can be really, really difficult for people to accept.

And it takes some time I think, especially if you're not going to therapy or talking with somebody openly about this, to be able to resolve and say, "Okay, but I get to decide what type of parent I am going to be," and whatever that is, is okay.

Interviewer: Right. It doesn't have to be what you see on TV or in the magazines or what the guy down the street is doing.

Jamie: Absolutely.

Interviewer: We create those own realities ourselves.

How do most men experience this when they describe to you how they're feeling? What are the words they use?

Jamie: A lot of the time, it's just "I'm not feeling like myself." There's a loss of identity, I think, coming into being a parent.

And some of the symptoms that we see more frequently with men is irritability. Lots of "I've been really snappy with my partner a little bit more, just quick to anger in general."

We also see an uptick in use of substances. So more frequent use of whether it's prescribed to things that they've been given to help with sleep or anxiety, or even just increase in alcohol use because there is that stress and trying to figure out how to kind of mellow out. That's something that we see pretty frequently.

Interviewer: Are some fathers more likely to be impacted by male postpartum depression than others? Are there some things we know?

Jamie: Definite risk factors are preexisting mental health conditions. You are far more at risk for experiencing a PMAD if you are already struggling with mental health conditions.

Now, that being said, it does not mean that it will necessarily get worse. It's just something to be very much aware of, which is why we talk about a lot of this from a preventative standpoint.

Also, if you are somebody that has struggled with depression or anxiety prior to having kids, staying on your medication and continuing to work with that is going to be pretty key.

Another risk factor that I would definitely want to touch on is when a pregnancy is unplanned or unwanted and you haven't had adequate time to truly process through that and kind of wrap your head around it, that can be a risk factor as well.

So I highly encourage people who are in maybe a situation that they're not 100% sure about to talk with their partners about it well in advance during the pregnancy so that you can work on communication and really just work on trying to set yourselves up for a healthy plan for self-care once baby actually gets here. It's important for both people, and I always like to include both partners as much as I can in our process.

Interviewer: At what point, if a guy recognizes some of the symptoms you talked about, should he be concerned and seek some additional help to get some tools to help get through this time?

Jamie: If you notice it at all, if it's really impacting your day-to-day life, it's impacting your relationships, impacting your work, that's a great time to reach out and get some help. I think that there is benefit potentially to getting on the internet and looking at some just online resources, just trying to understand it better and get some education.

Interviewer: And of course, make sure that the resources you're reading are reputable from medical institutions, that sort of thing. Are there other resources online you like?

Jamie: The online resources I do really enjoy because I think it's a good way for dads to find a community of people who are struggling with the same things and are being open about it without having to search too hard or run the risk of feeling like the person in their life is just going to say, "Well, suck it up."

If it looks like it is getting worse or you just don't quite know how to wrap your head around it, I think that speaking with somebody who is in the mental health field could be very warranted.

This is a really common thing. We see this. Statistically, it could be 10%, but I think it's much higher than that. So please reach out for help if that's something that you feel like you could be struggling with or even if you're just unsure. There is no shame in that.

Interviewer: For men that aren't quite to the point where they feel they need to see a professional, you've talked about an acronym called SUNSHINE that can help with postpartum depression. Does this apply to both women and men?

Jamie: Absolutely.

Interviewer: All right. Let's go through this, because this is a tool right now that our listeners could take away and start implementing right now and see if it helps. So let's talk about SUNSHINE.

Jamie: One of the wellness acronyms that we use quite frequently in our work is actually SUNSHINE. So what it is, is a series of different things that you should be thinking about when it comes to your mental and physical well-being during pregnancy and the postpartum period.

So it stands for sleep, understanding, nutrition, support, humor, information, nurture, and exercise. So those are all points that I think would be helpful in the preparation phase for having a kid, to think about, "How am I going to still try to get some of these things?"

And it's going to vary depending on where you are in that process. During the early stages, your focus may be on one of those things. And throughout the process, it might be able to expand into something else.

So I always advise my patients not to think about it as if you're not doing each and every one of these things, you're failing at your postpartum experience or you're failing at therapy. But just make sure that you are keeping them somewhere in the back of your mind because you are still an important person and your relationships are still important, whether you've got a baby in the picture or not.

Interviewer: So just give us one sentence for each one of the items in SUNSHINE. So sleep.

Jamie: Four to five hours as often as possible. Uninterrupted.

Interviewer: Uninterrupted. And try to get the standard eight to nine, otherwise?

Jamie: Absolutely, if you're able to. What that will likely look like, however, is especially in the early days taking turns potentially with your spouse, because they also need that time.

Interviewer: What about understanding? Expand on what that means.

Jamie: Understanding can mean a couple of things. You could again reach out and try to get a better idea of what other people's experiences have been like. Or you could also just get some education around what perinatal mood and anxiety disorders actually are.

Interviewer: And then what about nutrition?

Jamie: Nutrition, that's a tricky one. So this is not a great time to start a brand new diet plan. It's probably not going to be the top of your list of things. What we do want to make sure is that you are making sure you're actually eating and fueling your body. It's really, really easy to put your focus all on everybody else and sort of forget that you have needs also.

Interviewer: All right. So make sure you're eating and try to get as much nutrition as possible, knowing that maybe you might have to use some convenience foods.

Jamie: Absolutely. And preparation going into this can be really helpful for that, making sure that you do have some healthy things around the house. But I'm certainly not going to judge you if the thing you ate for lunch was a bag of M&Ms. Just get something in your system if you can.

Interviewer: Support.

Jamie: Support is something that we should start generating right from the get go, whether it's our family, improving our communication with our spouse, whatever that looks like. It's good to try and bring your support system in as long as that's a safe thing for you to do.

Interviewer: All right. And humor. Crack lots of jokes?

Jamie: Definitely. Hey, dads are known for their dad jokes, right? That's a thing for a reason. But being able to laugh at the situation sometimes really can help. Not only does it increase your endorphins and just make you feel better in general, but sometimes being able to find humor in the absurdity that can come along with parenting is not a bad thing to do.

Interviewer: Good tension release a lot of the times, yeah. Information.

Jamie: Information. Get good information about these things. Get good information about your mental health. When I say go to online resources, I think finding ones that are specific to dads' mental health through Postpartum Support International are great. I would suggest don't go down the social media rabbit hole of things that will probably make you feel worse about your parenting.

Interviewer: Does information also include just learning more about what it is to raise a child?

Jamie: Absolutely.

Interviewer: Because to me, that would be a major stress point. I have a friend that I don't know how many books he read before his child arrived, and he said it just made him feel so much better.

Jamie: Yeah, I think it can be a real help to people just having a better idea of what that could look like. The caution I will put on that is that there is a perspective for pretty much anything you can find out there. So maybe get some guidance from your pediatrician before you just delve into something.

Interviewer: Yeah, make sure you're getting some of the good books. Nurture.

Jamie: Nurture comes back to the self-nurturing piece of this. It is okay to talk about how you are feeling.

Interviewer: And feel. It's okay to feel. A lot of guys struggle with just even doing that or identifying what the emotion is.

Jamie: Yeah, absolutely. Or feeling like a dad in general. It's a big shift and we want to make sure you're taking care of yourself.

Interviewer: And it's okay to say, "Hey, I'm doing okay. I'm an okay dad." I mean, if you can't say, "I'm a great dad," go with, "I'm an okay dad," I suppose.

Jamie: Being a good enough dad is good enough. It's different for everybody. And people always balk a little bit about that idea, but there is a whole theory around the good enough mother, and so we do actually talk about that quite a bit. Dads fall into that category too.

Interviewer: And finally, in SUNSHINE, you have exercise.

Jamie: Again, I'm not saying go out and start a whole brand new plan and get a gym membership and do all the things that you've been trying to accomplish, but get some movement. That movement can just be going out for a walk once a day just to get some vitamin D and stretch your legs.

Interviewer: It's good for the body and the mind.

Jamie: It is.

Interviewer: Exercise, like you said, releases all those endorphins and makes you feel good, helps reduce that stress.

If those things aren't working, what's the next step that you would recommend a man take?

Jamie: I would recommend reaching out to even if it's just your primary care physician to say, "I'm struggling with this. This is hard." If you are actively involved in child's doctor's appointments, you could even talk to your kid's pediatrician about how you're feeling. They have a lot of really great resources.

Interviewer: Jamie, this has been a very informative, great conversation. I know it's going to help a lot of dads-to-be. Any kind of final thoughts as we wrap up this conversation that you would really want somebody to take away after listening?

Jamie: There are times when you're in the early stages where it just feels like everything is falling apart, but you're definitely not by yourself. You're not the only one that has struggled with becoming a parent or feeling like it's going to be like this forever. It's truly not. Get some support, and at the end of the day, it will get better and you're not by yourself.

Dr. Jones: You just had a baby and you're feeling a little or a lot overwhelmed. Surely this is common, but is this postpartum depression?

Being overwhelmed with a new baby is common, whether this is baby number one or baby number three, but when does this feeling of being overwhelmed suggest that the problem is more serious for the new mom and the baby?

Today, we're going to talk about postpartum depression. And in the virtual Scope Studio is Jamie Hales. And Jamie is the board co-chair for Postpartum Support International, our Utah Chapter, and she's a clinical manager of the Huntsman Mental Health Institute. Thank you very much for joining us, Jamie.

First of all, let's just dive right in. Well, what is postpartum depression? Why is it something different than just, "Oh my god, I'm sleepless and I'm overwhelmed"?

Jamie: Well, you've hit it right on the head. I mean, those are completely normal things that can happen with pregnancy, right? You're sleepy, you're feeling like you're not quite yourself, but I think that there is a difference for sure between really struggling with postpartum depression versus having what we would typically kind of term as the baby blues.

When we're thinking about postpartum depression, it's really more stuff that doesn't just come and go, right? After a couple of weeks having your baby, if you are still just really not feeling like yourself, and not sleeping when your baby is able to sleep, and possibly more irritable or more depressed, having thoughts of hurting yourself, anything along those lines, it's probably more likely to be heading into the territory of perinatal depression or anxiety versus just kind of a normal adjustment to having a baby.

Dr. Jones: Right. So I think all of us, particularly as new moms, feel like we are imposters, meaning we feel like someone gave me this baby and I don't know what to do. For new moms, we're all amateurs, but it's that feeling overwhelmed with this and being inadequate. "I can't do this. I need to check out. Someone needs to help me." But often women don't reach out for help. How common is this?

Jamie: It is absolutely the most common complication of pregnancy, which is why we need to talk about it more often.

I mean, if you really think about it, as an OB-GYN, you screen women for gestational diabetes. You screen them for gestational hypertension, any of these things that could happen. But it's been relatively new in practice to make sure that we're actually screening for postpartum depression and anxiety.

It impacts 1 in 10 men, which a lot of people don't think about, but it also impacts probably closer to 1 in 4 women, even though the official statistic is 1 in 7.

Dr. Jones: Right.

Jamie: And that's just because it's under-reported, is really what it comes down to.

Dr. Jones: I think the old-fashioned and probably still prevalent practice is you see women, deliver them, you see them for a day for postpartum, and this is the doctor, and then you have them come back for their six-week visits. But by that time, they've sunk or swum.

So, in Europe and in England, there's a midwife who goes and does a mom check. And unless we check at two weeks or three weeks and say, "How are you doing? Do you need help?" by the time six weeks comes along . . .

And a lot of women don't even come to their postpartum visit. We don't pick up as much as we should. So we are counting on the woman or her family, and that's why we're doing this podcast, this topic. When women or their family members see this happen, they need to reach out. So what should they do?

Jamie: I think that absolutely is key. As providers, if we see people, we absolutely want to make sure that we are asking every one of our new moms, "How are you doing?" Not, "How's the baby? How are you healing physically?" We have to really talk about, "How are you doing emotionally?"

And you're right, we may not get women in for those two-week or six-week appointments because sometimes insurance has changed or they're just feeling so underwater already that making it in for one more thing is really, really difficult.

My advice always to family members and to women in general is to speak up. If you really truly feel like your motherhood experience is just not going the way that you would thought that it would, getting around that stigma and actually saying, "I'm struggling. I don't know that this is normal," is a really helpful thing to do.

I think that there are a lot of people out there who have resources, and have the ability to jump in, and try to help you feel better, and to start getting back more to what your baseline was before you had a kid. So I think that that's a big piece.

And then for family members, please, please, please ask and make sure that you are paying attention to the emotional needs of those new parents, because it is harder for people to speak up and say, "I'm having a hard time."

Dr. Jones: Yeah, and it's not necessarily . . . You could have flown through the first one, but maybe you're not flying through the second, or maybe you had postpartum depression the first time and you didn't have it the second. Although women who've struggled with mental health issues before are a little more likely to have postpartum depression. Do I have that right?

Jamie: Yes, that's accurate. You're absolutely right. You could cruise through four pregnancies and not have any real postpartum symptoms. And then with that last one, you do. Or you could have really, really rough postpartum depression the first time and then not have it with your subsequent ones.

So it's important to make sure we're checking in with people during all of these different points in their motherhood journey to see how they're feeling. Dr. Jones: So if a woman has come right out, what do you do? As a reproductive endocrinologist, I think this is potentially the biopsychosocial model, meaning the psychological makeup of the individual matters, the social environment may matter, but there's the biology of having a hormone crash, and some women are vulnerable to that.

So when you think of these three parts that make up any kind of illness we might have, how do we approach this in terms of treatment?

Jamie: I'm really glad that you brought that up, Kirtly. I couldn't agree more. I mean, you do have this major hormone change that happens once you give birth, just the lack of sleep and all of the social factors that can change.

I think for a lot of people, becoming a mother is great, and maybe it was something that they were really excited about. It also could be the opposite. And it can be really tricky, I think, for people to recognize that all of those experiences are valid. So we want to de-stigmatize this as much as humanly possible.

Then you add the other kind of psychosocial factors into it. I mean, if you're in a difficult home situation or you don't have financial resources the way somebody else might, these are all things that could put a woman more at risk for experiencing complications. So it's good to assess really, I think, the full person.

Dr. Jones: It's a thing about humans. We're the only mammal species, we're the only primate species that shares our baby. We are willing, as a social group, to let others keep an eye on our baby. So you can say, "I really need to go for a walk. I need some help. I would love to just have 10 minutes to myself."

But there are people who need an evaluation. And at least for those of us who are OBs, we always think they need to check their thyroid because low thyroid can be a player in this and it's not uncommon. But some women need medication. I would think that even group therapy would be ideal for this, to hear other women struggling. Is that something that's at all available?

Jamie: Oh, absolutely. There are a number of group therapy options out there for people. And I think what makes that so effective as an option is really that peer support. Being able to hear the stories of other women and just recognize that you're not alone in what you're experiencing really goes a long way toward helping them understand that it's not a normal complication, but it's definitely a common complication to experience these things. It goes a long way toward getting that stigma to not feel as acute.

Dr. Jones: So how long does it last? I mean, does it have its own natural course?

Jamie: So I think because of some of the biological factors, there is a course that comes along with it. I mean, we see a lot of people start to feel better again as they get toward the end of that first year, just because there are so many things that come up during that year, so many really positive milestones and also just lots of challenges that kind of come along with the experience of being a new parent.

When we really think about, "Is this postpartum versus something else? Is it pre-existing depression? Are there other complicating factors?" I always think about what was your emotional state and your experience like before you had this baby?

And really, if something changed with your pregnancy or in your postpartum experience and you're having struggles down the road, but you can still kind of pinpoint, "Yeah, that's when things really got to be a struggle," I think it's okay to still refer to that as being a perinatal mood and anxiety disorder.

I have worked with people who are several years out from their birth experiences and they're still sometimes coming in to talk about birth trauma or navigating being a parent, and they're years out.

Dr. Jones: I think all births are pretty traumatic.

Jamie: Yeah, that's fair.

Dr. Jones: This is just me. It's like, "Oh my God, how did that baby ever get out there?" But I think that there are women who come in with this hope for experience, and what happened wasn't really what they planned and they can't let go. They're healthy baby, healthy mom, but they have problems. And so that is a special subset of problems around birth.

Jamie: And I'm really glad that you bring that up, especially that last piece, because what we as providers may think of as, "Oh, that was a traumatic birth," there are some that you can look at and be like, "Yep, on paper, absolutely that was a terrible experience."

And then there are a lot of other people that maybe they don't have that exact presentation of what it could have looked like, but we're not there inside them experiencing it, or even for partners watching it. And it's always important to ask people about what their experience was like rather than assuming just because Mom is healthy and baby is healthy that everything is okay.

Dr. Jones: Exactly. I think it's getting back to asking the mom how she is. But when is this problem an emergency? A woman isn't feeling well, when does either the patient or . . . And sometimes a patient can't recognize it, but a family member say, "She needs help right now, today, this minute."

Jamie: Like with any other condition, mental health conditions can definitely come in varying degrees. I think there's always an argument to be made for if somebody is not doing well, jump on it and get them in and give them a safe place to be able to tell their story and potentially be able to get on medication. Sometimes that can take some time.

What I would say, all the way on the other end of the spectrum, is if you are working with somebody or you have a family member or your partner or somebody else who it seems like they've really lost touch with reality, and there could be some postpartum psychosis onboard, that is something that we absolutely consider to be emergent.

So there is a difference between having really kind of scary, intrusive thoughts. That can be something that can come along with just having postpartum anxiety or postpartum OCD. But if somebody is having all kinds of strange, outlandish thoughts about themselves or the baby, and it doesn't bother them, or it seems like it's something that really truly isn't connected to reality, I would make sure that you check in and get them some help pretty quickly. Same thing with suicide as well, suicidal thoughts.

Dr. Jones: Yeah. So if a woman is thinking of either harming herself for her baby . . . I mean, we do have mental health professionals in our emergency rooms . . .

Jamie: Yep, absolutely.

Dr. Jones: . . . who are aware and know what to do. So if that's what it takes, you just need to pack everybody up and come right in and get help right away.

Jamie: One of the things that I hear . . . and I'm sure you do as well. I've heard from plenty of parents, "I didn't want to say anything, because I don't want people to think I'm crazy," or, "I don't want them to put me in the hospital or pack my baby away to somebody else." The reality is that is not something that happens very often at all.

Dr. Jones: No. It's very uncommon.

Jamie: Yeah, it's a big fear people have, and I think it's a big barrier to having somebody come in sometimes to actually talk about these things. But that's so unlikely that something like that would ever happen. I mean, everyone's thought is trying to make sure that both you and your baby are being served and taken care of, and nobody likes separating you guys out.

Dr. Jones: Yeah. Well, as we wrap up, I think it's important to know that this is common. I know people want to be the ideal mother, but ideal mothers get depressed. And it's very important for your own mental health and for your baby's mental health, because your newborn is keyed into who you are.

So if you or a family member is depressed and struggling, that baby is struggling too. So all of us need to chip in. It takes a village to get a mom and a baby through their first year. And the more that we are attuned, the more we ask, the more likely we're going to have a healthy baby and a healthy mom make their way to Year 2. What fun.

Jamie: Yep, that is very true.

Dr. Jones: So, Jamie, thank you so much for joining us. And for all of you who are listening, thanks for joining us on The Scope.