To think men genuinely can suffer from PND?

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My friend has received treatment for PND after her second child and thankfully is coming out of the worst of it now. However, her husband is now getting counselling for male post natal depression and her response to this was complete anger. She resents him claiming to have what she had which she claims was due to a hormonal imbalance and can't take him seriously.

I haven't said this to her but I think he may well be genuine and deserving of support. I don't know him ever so well but I find it entirely possible that he's feeling as sleep deprived, shell shocked, trapped and overwhelmed as she is. Yes it might not be hormonal but surely the huge upheaval that having a child brings could send either parent into depression? I know health visitors tend to look for it more in the mother and maybe this means men get overlooked. I know this couple have money worries too and that pressure must affect him too.

Am I being unreasonable to think his mental suffering could be as real as hers?

For the majority of women, there are additional physical and social challenges at this time that are NOT experienced by men. Breastfeeding, for example, is a major source of rumination and distress for women that men will NEVER EXPERIENCE.

Yes, and I actually firmly believe that the erasure of women does not help. Men, as has been pointed out, don't get PND because they were never N. N is an extreme situation for women, challenges of a new baby aside, and it does not help women if we collude in obscuring the challenges that pregnancy brings in and of itself. Not only that, it gives in to the anti abortion crown who can't accept that forcing a woman to continue a pregnancy against her will is torture. Why would they accept that pregnancy is profoundly difficult if the effects are equally experienced by people who can't experience it?

Also, it hides the other factors there may be at play.

I developed PND after experiencing extreme anxiety in my second pregnancy. My first birth was not a scary, life-threatening sort of experience that would have scarred dh, but physically I had a very lengthy recovery (about eight months before I was walking freely/incontinence/perineal trauma needing repair).

The fear of having a similar experience and being told by a consultant that my first birth (a Kielland's forceps) had been "straightforward" and "not traumatic" when I burst into tears during an antenatal appointment actively created the conditions for my depression, which arose out of intense stress and fear of childbirth. I was terrified of experiencing more physical trauma, feeling guilty that I wanted a CS instead of what I had been told by the consultant and supervisor of midwives I should do was "best for baby" e.g. a natural birth, terrified that I wouldn't be listened to in birth and might experience even greater trauma etc. These natural worries, which I was told were "unwarranted" and "unnecessary" slowly morphed into much more extreme and irrational worries e.g. fear of a difficult birth became fear of every single possible complication a woman could ever experience, including my death or the baby's death. When I was given a diagnosis of OCD as a result of this, it made things a million times worse because it triggered all sorts of other fears of having a long-term mental health condition that might taint my children's lives as my father's alcoholism had tained ours, and not being able to cope as a mother. It was also faintly ludicrous, because I was given a life-long diagnosis of OCD based on fears that were exclusively related to pregnancy and childbirth, largely based on reporting having had worry behaviours as a child like not wanting to skip on cracks (which in my worried, addled state I felt were a sign of everything there was to come, though looking back now from a state of wellness, were fairly normal and commonplace, especially for a child growing up in an alcoholic home).

In the end, I had an unmedicated water birth with no trauma, but the damage caused by months of extreme stress and worry was done, and on Day 5 the real nightmare began.

So much of my story - and I was to learn later, of many women's stories - is bound up in experiences that commonplace for women and reflect all sorts of other women's issues. My husband found all of this incredibly hard, it was hugely distressing for him to see me unravel and a very difficult time for all of us. If he had become depressed because of it, it would have been understandable. Yet that wouldn't change the huge influence of women's issues on the course of my PND.
I still believe if my worries and concerns about physical trauma in childbirth had been more sympathetically approached, much of what I experienced could have been avoided. This is something a man just can't have experience of in the same way.

Well yes, that's the other issue with treating hormonal/situational differently, because there's not some simple test they can easily do to find out if it's hormonal. I hope that there is at some point in the future, but for now we don't have anything like that, it isn't possible to extricate. For "normal" depression (which can also be brain chemistry vs situational) and PND.

If you want to argue the semantics of "natal", BTW, consider that in most of the rest of the English speaking world, it is called "Post partum depression", partum = to bring forth, to give birth, childbirth.

The amount of services set up and accessible for each gender is not relevant to the point that talking about "male PND" takes the shift of focus away from women. It's possible to raise awareness and focus of mental health in general, without taking away the seriousness of PND. It's not about demanding women have all of the access to mental health services. I think we're on the same page here :)

the main reason male suicide rates are higher though is that men choose more lethal methods.

This is true. Three times as many women attempt suicide than men. Yet four times as many men die from suicide than women. Men tend to be more successful. I also suspect that women with dependent children, although they might suffer from PND, are less likely to commit suicide because of fears over who will take care of the children. The stats back this up - women with dependent children (with the exception of those suffering extreme PND or psychosis) are less likely to commit suicide than their child-free peers, whereas men with children have identical suicide rates to others in their age group. Likewise when you have family suicides, when initiated by a woman the evidence tends to point to her taking this drastic step because she fears that she cannot care for the children. Whereas when a man kills his children, it's more often DV related, to punish the children's mother, or out of a sense of "nobody else can have them, they are mine".

That leads me to think though that the children aren't having a magical protective happiness effect, but more that mothers struggle through depression and attempt to cope with feeling suicidal without actually doing anything about it, which must be a horrendous place to be.

Maybe they should rename it Post Birth Depression then men could be taken seriously too?

No. Because men don't experience birth. Which is the entire point. If you want a fluffy gender neutral name then call it new parenthood adjustment depression or whatever, (although that then leaves out parents of second children, children who die shortly after, before or during birth, parents whose babies are adopted etc etc, so postnatal would seem the most sensitive) but the entire point is that it is a totally different experience for men and women. That is how our culture is, and probably every culture in the world, because even going past culture, the experience would be different because the mother's experience is so much more physical. And everything duplodon said :)

If PND were primarily hormonal it would be treated with hormones - which of course it usually isn't.

'Baby blues' is primarily caused by a steep drop in progesterone level, birth itself and intense sleep deprivation but in most women it resolves spontaneously. PND is something else (though it can start with severe baby blues which fails to resolve).

PND is seen primarily as a psycho-social illness and men can also experience it. They tend to get it less because they are rarely primary care givers and their lives change less than women's following childbirth - but they can still get it.

PND is a response to the experience of being a new parent - why shouldn't men get it too?

Would also add that most UK mothers are not breastfeeding by the time their babies are six weeks old. Hormonally they are like a woman whose children are older. In hormonal terms the 'physiological norm' is what you have while breastfeeding. Not sure what impact this has - difficult breastfeeding is associated with higher rates of PND, normal breastfeeding with lower rates of PND (than bottlefeeding).

Not quite the same as an older child. You produce the milk making hormones in abundance but if you stop or never breastfeed, that also causes a hormone crash as your body dries up the milk. This happens whenever you stop breastfeeding but I would imagine in the early days it compounds with the post-birth hormones as well.

Even if you entirely discount hormones, I still feel that there is NO NEED to term this "PND" for men and that it's about appropriation.

A lot of the psychosocial circumstances that contribute to PND and maintain it apply more to women than to men. Many women who are not breastfeeding who have PND, for example, experience hugely disproportionate levels of guilt and grief that they didn't/couldn't- it's played out on MN too.

The simple reason we shouldn't call depression after a child is born "PND" for men and for women is that men are RARELY the primary care giver, and PND is very much complicated by the demands of being a primary care giver to a tiny dependent infant.

By all means, a man can be depressed, as he can at any other time of his life. Any major depression should be taken seriously and treated aggressively to reduce the dangers associated with this illness. However, unless the man happens to ALSO be a primary care giver with all the responsibilities and the extent of a change of life's role that most women have, it's muddying the waters to make it about childbirth or pregnancy. Perinatal mental health services provide for women because of the unique challenges of childbirth and pregnancy biologically, but even discounting these, socially the reality for most men of being depressed in this period of time is very different. They are far less likely to be expected to continue to care round the clock for an infant, and fewer still would be expected to provide this care with no support or breaks at all.

Men don't get pregnant. Men don't undergo childbirth. Few men are primary caregivers in the initial weeks and months in the same way women are.

In any case, as I said before, PND is a term that people use for ease to indicate that a woman is having a major depression after the birth of a child. It is not actually a diagnostic term - you have major depression or you don't. I can see absolutely no reason to call major depression PND for men, regardless of what has triggered it. If it's depression triggered by being a parent that isn't complicated by the experience of being a primary care giver for a dependent, then as far as I'm concerned, it's misleading to call it PND.

In fact, yes, if we're calling it a gender neutral name, let's start by defining it as a "major depression complicated by being primary care giver who is expected to be on-call 24-7 to a tiny dependent infant". Not very catchy, but if we agree on this as a definition of PND and it happens applies to an individual man based on his specific circumstances, then he can call it PND. If it happens to be that he has a major depression after the birth of a child where he is NOT the primary care giver, I can't see what adding the postnatal element adds.

If we're going to go with a situational definition that doesn't point to hormonal difference or the physical, hormonal or biological adjustments that women are making in the year after childbirth, whether or not they are breastfeeding, then at least let's be real about why PND may present different challenges to major depression at other times in someone's life. It's because it's a time in life when you really CAN'T AFFORD to be ill without getting additional support because it can have such an impact on the baby. Many of the things someone can ordinarily do to recover or maintain wellness are out of reach because of the natural demands of this time, which in most societies and cultures, fall on the woman to provide in the main. A father would have to be very unusually hands on to experience the level of demand placed on the average woman, and it is unlikely that in anything but the most extreme circumstances he would be providing sole parenting responsibilities in the context of a relationship (which is not at all uncommon for women). Even when I had SEVERE PND, I still had two children at home while my husband went out to work every day, though I was barely able to function and had to get myself to appointments etc. My husband was, and is, very supportive and caring, but this is just the way things seem to go for women. I wonder how many men experience similar.

What about men who are struggling to bond with their babies? Or distraught by the changes the baby has bought to their relationship?

I think so OP. I had PND and while i don't think dh ever got depressed per se seeing me go through it has definitely changed him. It was a very stressful time. I would say he suffered from major stress.

If PND were primarily hormonal it would be treated with hormones - which of course it usually isn't.

That doesn't follow at all. If only medicating was as simple as that!

Minifingers, they can go speak to their GP about medication and therapy options to ease and manage their distress without needing to call it PND.
It doesn't have to be called PND to seek advice or treatment.

If a father is depressed because he is unable to cope with the transition to fatherhood - perhaps has high anxiety levels, is struggling to bond with his baby, maybe traumatised by witnessing the birth - why should this not be considered PND'?

Plenty of women develop PND following a completely happy and untraumatic pregnancy and birth. They are depressed because of the experience of parenting a small baby. I really don't see why men can't experience this too.

It is a moot point. There is no diagnostic category of PND anyway, it's just used by people in conversation. The diagnosis in this country is major depression, whenever it arises.

Are you suggesting there should be specialist services for perinatal mental health for men to provide specialist advice on medication in pregnancy or childbirth? To have father and baby units so that men requiring hospitalisation don't need to have time away from their babies? Why do you think these services have arisen for women and not men?

Personally, I think that while men may experience psychological challenges on the birth of a child, very, very few men are faced with practical challenges of the same intensity, frequency or duration as women during this period of time, or the fall out from this on the course of the illness, even if they are entirely supportive of their partner. This doesn't mean they can't have severe depression that requires treatment. How would calling that depression "postnatal" support these men particularly? What would calling it PND do for men? Do you think PND support groups should be open to men, so? I know MANY women who would feel excluded from such supports if men were included.

Also one of the major benefits for me receiving specialist services was I could attend weekly therapy with my baby as I had no other option. Would you envisage many men would need to attend therapy with their baby in order to be able to access services? I'd be surprised if this were common, while I can think of fifteen women off the top of my head who couldn't access personal therapy due to childcare issues.

Personally, I think that while men may experience psychological challenges on the birth of a child, very, very few men are faced with practical challenges of the same intensity, frequency or duration as women during this period of time, or the fall out from this on the course of the illness, even if they are entirely supportive of their partner

I'm not convinced. When I wasn't able to cope with horror sleeper DS1, DH stepped up and spent months getting up five or six times a night with DS, then getting again up at seven for a long demanding day at work, then coming back six to spend an evening rocking a screaming (colicy) baby so I didn't go entirely insane. I don't think he did less than me overall and wouldn't have blamed if he had got depressed.