Fathers can get Postpartum Depression too!
J. T. is in for his routine visit and is growing at the 80% in height and the 60% in weight. He cackles once when I palpate his abdomen and looks up at his dad when I listen to his lungs. Though I'm finding this behavior delightful, Howard hardly notices. He looks worried. "Is his head big enough?" "Does it hurt J. T.'s back if he lies on his stomach?" "He always strains his face when he poops. Is that ok?"
Worry seems to be on the job description of most new parents. Each of Howard's questions alone seems resonable; however, this dad has an extraordinarily long list of questions and can't be reassured. He is an attentive father who reads everything about babies on the Internet. He collects ideas from friends and family. He is hypervigilant in his care: getting up several times at night (while the baby sleeps!) to be sure everything is ok, counting every calorie the baby eats, keeping an elaborate diary of the child's sleep, eating, and elimination. Though the data piles up, the questions and worries keep coming. "Anxious attachment," a term used by some professionals, describes the budding relationship between Howard and his baby. Though J. T. is thriving now, babies can eventually sense this anxiousness and over time can look and even act anxious themselves.
Anxious attachment is seen as a form of postpartum depression and can occur in either the mother or the father. This conditiion does not look like classic depression: a "slowed down" parent who becomes teary and sad, has trouble concentrating, appears distracted, and becomes less involved with their baby. Howard is super involved but cannot trust his instincts or learn to read his baby's behavior accurately. When asked, Howard will state that he is "not depressed." "I'm just worried," Howard explains. He, and others like him, need help: frequent contact and support, counselling, and sometimes medication.
When I care for young families I follow the "rule of three." If a parent asks a third question and cannot be reassured, but follows with yet another concern, I start looking for anxious postpartum depression.
Reseaarch by M Sills, S.Shetterly, et al (http://pediatrics.aappublications.org/cgi/content/full/119/4/e829) confirm that depression in even one parent increases visits to the primary care provider and ER and reduces well-child visits (especially with the older children). When patients are "frequent fliers" as we call them in our practice, consider depresion in either the mother or father.
Now my "rule of three" kicks in. When Howard ask his third question I stop trying to reassure Howard. Instead I say, "I can see you love you baby so much that you want only to do what's best for him." Acknowledging his list of questions as an expression of Dad's love seems to slow down the questions. Howard takes a deep breath, smiles, and admits to being a "bit worried about the baby." Now we are talking about his real worries not the symptoms of his concern.
Dr. T. Berry Brazelton would describe this approach as the Touchpoint's technique of "acknowledge the parent's passion." In this case this acknowledgement opens the door so now we can discuss the difference between everday worries and anxious depression. (It surprises men to learn that research shows that spouses can have hormone changes during their wife's pregnancy and that these changes can contribute to his depression as they do in the woman.)
Howard describes his new job responsibilites and the extra time he now must spend away from home. Research shows that many new fathers worry deeply about the strain on time and money that new parenthood creates.
Next, I set up a specific time to call Howard weekly for the next three weeks and set up a followup visit in a few weeks. Knowing that I will contact he and his wife seems to harness his worries and decrease his calls to me. I suggest he jot down any worries so we can be sure to discuss them at the phone call or visit.
At the following visit I discuss the concept of anxious depression a bit more and ask about Howard's personal and family history of depression. In addition, I ask about alcohol use since this can contribute to or cause depression at any time in a patient's life. Howard promises to go back on his exercise program and cut back on his caffiene. He agrees to accept a little more help from family and friends and he his wife plan a time to go out to dinner on a well-deserved "date night."
Howard's history and symptoms were significant enough to put him on an antidepressant. After three weeks Howard said "I feel like myself again." By JT's four-month-visit Howard, his son, and wife are much better. Howard brags about his son's new trick of rolling over, and laughs when JT swats at Howard's nose. Howard is back, more able to be present with his son and to find joy in these precious moments. Likewise, I'm back on track as their provider. Addressing the cause rather than the symptoms allow me to feel more compassion and be more able to use my skills and knowledge to help these parents be the parents they want to be.
Posted by Jan Tedder, BSN, IBCLC, FNP at 6:38 AM