What Men Don’t Understand About Pregnancy (Postpartum Depression)

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Alok Kanojia (1:03)

Hey, chat. Welcome to the Healthy GamerGG podcast. I'm Dr. Alok Kanodja, but you can call me Dr. K.

I'm a psychiatrist, gamer, and co-founder of Healthy Gamer.

On this podcast, we explore mental health and life in the digital age, breaking down big ideas to help you better understand yourself and the world around you. So, let's dive right in.

All right, chat. Today, we're going to talk about postpartum depression and postpartum parenting. So, if you have a partner who's just had a kid, what should you do to support them in the best way? Now, if you're a dad out there, I think this is tricky because we're oftentimes blamed as dads and men and all men are trash and all that good stuff which we see on social media for not being supportive enough. But I think there are a couple of important things to remember. The first is that most of what we learn how to do, we learn from our parents. And let's say 40, 50 years ago, dads were not nearly as active as they need to be today and as expectations are high today. So oftentimes men are blamed for not providing something that no one ever taught them how to do. And that's what we're going to try to correct here today. So in the United States, there's a pretty controversial trial that's going on right now. A woman named Lindsay Clancy is on trial for murder after killing her three children. And her defense, which there's ample evidence for, is that she had severe postpartum depression that turned into postpartum psychosis. And psychosis is when you have a break from reality. And during her psychotic period, she actually killed her three children and then jumped out of a window on some high story and is now paralyzed from the sternum down. And so I think we have this legal defense of, yeah, I'm not responsible because I'm insane. And I think postpartum psychosis is one of those diagnoses that that defense is kind of for, because we know that in psychosis, you literally have a break from reality. You think that you've been possessed by the devil, and you really believe that, and you act accordingly. And this has created a lot of problems on the internet. People are breaking up over it, like women are supporting Lindsay Clancy. A lot of men are really confused by this. I think a lot of people don't understand what psychosis really is, and they sort of think about it as depression or anxiety, where you're still tethered to reality. The really scary thing about this is also that she was in psychiatric treatment. She was declining and getting worse. She saw, I think, seven health care providers, was hospitalized at some point, was prescribed 13 medications, so she was trying to get help. People were trying to help her, and this still happened. And that's kind of why I'm making this video today, because I think the postpartum period is really hard to manage. And part of the reason it's hard to manage is because if you're a dude, you were never taught how to take care of your wife in the postpartum period, because there's a really good chance that your dad was not super active in the postpartum period, or maybe you were a little baby, so you don't really observe it. And so it's like really hard to know what to do as a dad. It's a really scary situation. And what I see most dads do is they try their best, and they actually do try, but they actually don't know what the goal is. So parents, you need to do two basic things. One is support self-efficacy, which is kind of like interesting. So it's not just that you need to do work, but the primary mental health goal is to help your partner feel like a good mother. So it's not to like assuage her concerns about appearance and things like that. Like if she asks you like, Hey, is the baby weight gone? That's like a debate, right? There's no right answer to that. And so there's all this stuff that we're kind of like scared as dudes, like, oh, my God, like, what do I say? Like, the baby weight isn't gone. Like, how do I proceed with this? So this is where the main goal is to support her self-efficacy. The best protective factor for her to not get depressed, which we'll talk about in a second, is for her to feel like she's doing a good job. And that's our goal. The second thing is that we want to actually do some of the work, which we will get to, which will then help our partner feel self-efficacious. But oftentimes, what I find is that most dads do like one or the other, right? So dad shows up, says, I'm going to be an active parent. I'm a change diapers. I'm going to do all this stuff. And that's where all of their focus and energy goes. And they don't provide the right kind of support. Or what they try to do is provide moral support and be supportive and things like that and say nice things to their partner, but they're not supporting self-efficacy, so it doesn't work as effectively as it could. So these are the two things that we're going to really focus on today. Now, let's start with some statistics because this is a scary AF, okay? So on a given day, 10,000 live births, about 1,000 to 2,000 women are going to end up with postpartum depression. This is a staggeringly high number. What's even scarier is about two per thousand women will end up with postpartum psychosis. So this is the situation that Lindsay Clancy is presumably in. I think there's ample like medical evidence for that. Like, I mean, she was in care. There's lots of notes. This is not like I showed up in court, and by the way, I'm insane. There's just piles of evidence that she was really moving towards postpartum psychosis. And so it's two per thousand. So that means that every day in the United States, about 20 women will enter into postpartum psychosis. And then this is also kind of scary, arguably reassuring. About 6% of people who wind up in postpartum psychosis will have a serious suicide attempt or commit suicide. About 5% will be violent or homicidal to other people. So on the one hand, these numbers are really low, right? 10,000 live births, 20 people are psychotic, 5%. So one of those women will try to kill themselves or kill somebody else. So that's like pretty small, like one per 10,000. But it's also like scarily large because that means it's kind of happening every day. And it could be happening in your situation. So how do you detect postpartum depression and postpartum psychosis? This is not really your job as a partner. This is the job of a medical professional. Here's an example of the standard that people use. It's called the Edinburgh Depression Scale. There are some criticisms that this depression scale doesn't really pick up psychosis. But basically, like the features of postpartum depression are the same features as regular depression or unipolar depression. So we'll see changes in appetite, changes in interest, feeling guilty, having a lower energy level, difficulty concentrating, feeling sluggish, slow, or even activated and potentially suicidal ideation. Now, the tricky thing about this is that many of these things are a normal part of postpartum, right? So difficulty sleeping because you've got a newborn, low energy levels because your body just pushed out and grew a whole new child. You lost a lot of blood from the uterus. There's necrosis going on in the uterus. Like there's all kinds of weird stuff going on. So that's what makes things like really tricky, is that if we look at the features of depression and we look at the normal course of delivering a baby, there's a lot of overlap. So there are a couple of things that I want y'all to be specifically on the lookout for. But generally speaking, this should be the responsibility of your partner's pediatrician or obstetrician to screen for this, like everyone kind of looks out for it. Key things for you to keep an eye out for, first of all, sleep. So if there is a sense of lack of fatigue despite not sleeping, that's a huge warning sign. So this is what's kind of interesting. For a lot of women, the first time they get diagnosed as bipolar instead of unipolar depression is in the postpartum period. So women can have a history of depressive episodes, and then after they have a kid, they like convert to bipolar. It's not that they convert to bipolar, they've always been bipolar. One of the key risk factors for a manic episode is disturbed sleep. So this is where like once their sleep gets messed up, their underlying vulnerability for bipolarity like kind of comes out. Okay, so you really want to be paying attention to sleep. You want to be paying attention to an inability to sleep, disturbances in sleep, if their sleep is really messed up. That's a very concerning sign. Second thing to look out for, this is highly specific, is something called anhedonia. So this is the inability to experience pleasure from activities that you normally find pleasurable. So energy levels will be low. You may have difficulty concentrating. You may not be sleeping great. But one of the key things about the postpartum period is that fun stuff should still be somewhat fun. People should be able to derive, sure you're exhausted, but you should be able to derive some joy, you know, a month. And remember, we're talking, this is like up to 12 months after delivery, right? So like a month in, your partner should be able to enjoy certain things, whether it's watching a movie, whether it's spending time with the baby, whether it's spending time with you, fun stuff should still on some level be fun. So anhedonia is highly concerning. A couple of other things to look out for are extreme versions of persistent emotions.