When Mark Williams and his wife, Michelle, decided to start a family, they never imagined the challenges ahead.
“In 2004, I had no knowledge of mental health,” said Mark Williams, founder of the online support network Dads Matter UK. “I was 30 years old. My wife and I had really good jobs, a house, and were planning to have a baby.”
Although his wife was healthy throughout her pregnancy, her labor was “horrendous,” Mark said. After 22 hours of labor, the doctor announced that Michelle needed an emergency Cesarean section.
“Instantly I thought my wife was going to die, and also the baby,” Mark recalled. “It was the first time I had a panic attack. I didn’t know what it was.”
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The C-section was successful, but two weeks after returning home, Michelle developed postpartum depression. Mark quit his job to take care of her and the baby, which he said left the family “thousands in debt.”
Mark said. “I was worried about money, (and) I was worried about my wife, how long it would take for her to get well.”
Isolated from family and friends, Mark felt anxious and overwhelmed. By the time his son Ethan was 8 months old, Mark was having suicidal thoughts.
Though he didn’t realize it at the time, he was experiencing postpartum depression, which occurs in around 10 percent of new dads.
Why PPD in men goes unnoticed
One reason cases like Mark’s can go undiagnosed is that depression in men is particularly hard to spot, said Dr. Will Courtenay, psychologist and founder of the online community Postpartum Men.
There’s a “very powerful and prevalent myth” that men don’t get depressed, explained Courtenay. “It’s so powerful that even trained clinicians are less likely to correctly diagnose depression in men than in women.”
Men’s depression can also look different from women’s, said Courtenay, and it rarely matches prevailing stereotypes about the illness.
“We picture in our minds somebody sad and crying. We can see that in men, but it oftentimes doesn’t look like that,” Courtenay said.
Instead, depression in men is characterized by behavioral changes ranging from increased aggression and impulsiveness to withdrawal from others. Other symptoms include physical pain, such as headaches or digestive problems, and a loss of energy.
For Mark, changes in his personality signaled that something was off. Normally “a smiley person,” Mark said he began picking fights for the first time in his life. He also found himself turning to alcohol to cope with the stress.
“My mind was racing constantly. ... I remember punching a sofa and breaking my hand,” Mark recalled. “I couldn’t tell (my wife) how I was feeling because I was afraid it would make her worse.”
Underlying causes
“The thing that best predicts whether a (new dad) will be depressed is whether his partner is depressed,” Courtenay said. “Half of all mothers who have postpartum depression have partners who are depressed.”
Between 9 percent and 16 percent of women suffer from postpartum depression (PPD), according to the American Psychological Association, compared with about one in 10 men.
One of the main causes of postpartum depression in both genders is sleep deprivation, which is almost a given for parents of a new baby.
“We know that when normal, healthy adults are deprived of sleep for a month, they can start to develop clinical signs of depression,” explained Courtenay.
Both genders also experience major hormonal changes during the pregnancy and postnatal period. Men’s estrogen levels increase while their testosterone levels decrease.
“These hormonal changes can really wreak havoc on a man’s functioning,” Courtenay said. When combined with sleep loss, he said, these hormonal shifts can create a “perfect storm” with depression peaking in men during the first three to six months after a baby's birth.
Another unique cause of paternal depression is anxiety over fatherhood, which has taken on new meaning for modern dads.
“Most dads say, ‘Of course, I want to be involved,’ but they don’t really have models for what that looks like,” Courtenay noted. “Most men today had fathers who had ... a complete hands-off approach to parenting, so that leaves these new dads uncertain about what to do. Well, that uncertainty can quickly lead to anxiety, and we know that anxiety postpartum can often lead to depression.”
Men are also more likely to experience postpartum depression if they have a previous history of depression or are unemployed or have a difficult relationship with their partner, studies have shown.
'An enormous strain'
So why does it matter that so many dads are suffering in silence? Because fathers aren’t the only ones affected, said Courtenay.
“It’s really important for fathers to know that their depression really does have a huge impact on their kids,” he explained.
Not only are dads with this illness less likely to sing, tell stories, and read to their children, they are also much more likely to spank their 1-year-olds. Additionally, paternal postnatal depression puts children at a greater risk of behavioral problems and psychiatric disorders later in life, according to several studies.
Not to mention that it puts an “enormous strain on everyone in the household” when both parents are depressed, added Courtenay.
For Mark and Michelle Williams, their experience with postpartum depression was so traumatic that it discouraged them from having a second child.
“We’ve only got one son, and that was due to the fact that we didn’t feel that we could go through it all again,” Mark said.
'Changed for the better'
But, despite their earlier struggles with postpartum depression, Mark said his family’s life “has changed for the better” in recent years.
In 2011, after a breakdown finally forced him to seek treatment, Mark learned about postnatal depression in men and founded Fathers Reaching Out to begin raising awareness.
Now both he and Michelle work in the mental health industry and have become advocates for mothers and fathers suffering from postpartum depression.
On Father’s Day of 2015, Mark launched Dads Matter UK to create a network of support groups for fathers in the United Kingdom. It will be expanding to reach dads worldwide this fall.
“It’s important that men know that even though (postpartum depression) can be a very, very serious condition that can even be life-threatening ... it can be treated,” said Courtenay, whose organization, PostPartum Men, hosts an online forum for dads to share their stories.
For Mark, things have definitely improved. He said of his son Ethan, “We get on great. We’re doing fine.”
Editor's note: This story was first published on July 1, 2015, and has been updated.
Visit PostpartumMen.com and DadsMatterUK.org for more information. If you believe you may have postpartum depression, contact a licensed mental health professional. If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline immediately.