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New dad suffering from postpartum depression

The Challenges of Managing Mental Health and Substance Use Amongst New Fathers

The Paradox of Parenthood: Unsurmountable Joy and Excessive Stress

Any parent can attest to the challenges that having a child can have on both an individual and a relationship.  Becoming a parent is accompanied by much excitement and joy, but it also comes with challenges, frustration, and stress.

To put this level of reported stress into perspective, one study showed that “the drop in life satisfaction during the year following the first birth is even larger than that caused by unemployment, divorce or the death of a partner” (Max-Planck-Gesellschaft, 2015).  Although some went on to call this a controversial study due to the magnitude of the claim, it is undeniable that, for most people, stress levels soar in the first year of parenthood.  It can be confusing for such a joyous life event to also bring a large amount of stress, which, in turn, can create much dissonance for someone.

Postnatal Depression Amongst Fathers

Although both men and women are impacted by postpartum symptoms as well as challenges with managing mental health after the birth of a child, our Manhattan depression treatment professionals would like to focus this post on new fathers and their journey through postpartum depression and anxiety. The reason for this is that there is little research or even validation, that fathers can and do struggle with postpartum symptoms just as much as mothers. In fact, one in ten fathers experience prenatal and/or postnatal depression (Paulson & Bazemore, 2010). At Fifth Avenue Psychiatry, our depression psychiatrists in Manhattan have found this to be a common issue with male clients who have become new fathers.

People often question fathers and their ability to be happy or manage stress following the birth of a child. This is further exacerbated when mental health or substance use issues pre-date having children and the prior tools that did work no longer feel accessible with the changes that children can bring.

Postpartum Symptoms in Fathers

Postpartum Disorder, or Peripartum Depression, is a depression that can impact women during pregnancy and after childbirth. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), characterizes it as: “Depressed mood present most of the day, loss of interest or pleasure, insomnia or hypersomnia, psychomotor retardation or agitation, worthlessness or guilt, loss of energy or fatigue, suicidal ideation, impaired concentration or indecisiveness, and change in weight or appetite.”

Although this diagnosis is for women, more research and awareness are bringing attention to the fact that men can exhibit symptoms as well. Research has shown a couple of key differences for men. One source states:

While depression can present as a dysphoric mood with reduced activity for both men and women, men are more likely to display anger, hyperactive behavior, irritability, and to have lower impulse control…Additionally, depression in men may be masked by interpersonal conflict, somatic complaints, and drug and alcohol use and avoidance behavior. (O’Brien, et al., 2017)

Postpartum Symptoms and Substance Use

When an individual is already struggling with managing alcohol or substance use, the addition of new stress and potentially new mental health symptoms can exacerbate an already difficult-to-manage situation. When an individual is in recovery, old symptoms that seemed well managed may be re-triggered by the introduction of a new life stressor.  In addition to the general life adjustment of having a new baby and the toll that this can take on both parents and the relationship, other factors, including sleep deprivation, hormonal changes (even for fathers), and feeling disconnected from the baby and partner can all play a role in creating risk factors for an increase in mental health symptoms or substance use.

The Challenges Utilizing Common Strategies for Sobriety

As discussed previously, stress is a naturally occurring and unavoidable factor with children. For most, stress and anxiety were the original triggers to use, so the reoccurrence can cause old patterns or thoughts to reappear. When stress is at heightened levels, previously used tools may not be enough. When an individual has trouble doing things with the increased demands that a new baby or young child can bring, utilizing tools under new time constraints can be particularly difficult to achieve. There is often a feeling that there is never enough time in the day and not all needs can be sufficiently met.

When an individual is in recovery or is contemplating sobriety from a substance or alcohol, one of the biggest tools is to create self-care or outlets for stress. For some people, this might be in the form of exercise or increasing interest in a hobby, and, for others, it may be engaging in more structured tools such as meditation. When there is not enough time in the day, self-care practices are usually the first things to go.

Another common tool to mitigate relapse or use is to seek out support. Support can be in the form of something more formal such as a 12-step program, therapy groups, or individual therapy. For others, support may be creating time to spend with friends or a partner. However, when there is a new baby or young children in the home and too many demands, this again can be one of the first things to be removed from a healthy routine.

It is also not uncommon for relationship satisfaction to significantly decline after having a child and this can further deteriorate the connection that partners feel and subsequently, the support they receive from each other.

Suggestions for Finding Balance in Parenthood

There is no easy fix and finding the right thing that works for each person takes time. The idea that it gets easier as children get older is true for some, and, for others, “easier” just means that the challenges become different. However, despite these challenges, there is a way through. If you have trouble implementing changes on your own, that is where a therapist can help you navigate the challenging terrain of parenthood.

The suggestions below are for all parents, but parents who struggle with an underlying mental health disorder or substance use disorder need to prioritize these suggestions more than the average person.

  1. Reconceptualize what taking a break or self-care means. Before children, self-care can mean a two-hour walk in the park or a weekly night of pick-up basketball. After children, this may feel impossible. The key is to start small.  A twenty-minute walk is better than no walk. Throw out the old expectations and make room for what will currently work.
  2. Create a routine. When you are exhausted and stressed, it is difficult to run out the door at the last minute to get a workout in. If you create a plan, with your partner, a family member, babysitter, or friend, ahead of time, you are more likely to stick to it.
  3. Create accountability. If you sign up for something ahead of time and you are invested, then you create more accountability and likelihood that you will follow through even if you are tired and not feeling up to it.
  4. Seek out support and connection. Being able to express what you are going through with your partner may help. Being able to connect with your partner about the stress you may be feeling can be helpful to both parents. Sometimes this is through informal conversations, and sometimes it is through purposefully carved-out mini date nights or even couples therapy.

If finding the balance and getting support isn’t helping to work through the challenges of early parenthood, or if, despite finding balance and support, addiction or mental health symptoms are not being fully addressed or managed, then it may be beneficial to speak with a Manhattan addiction psychiatrist. Sometimes being able to talk things through on a deeper level or learning and utilizing more specific cognitive behavioral tools and strategies will be beneficial.


Max-Planck-Gesellschaft. (2015). When new parents become unhappy, brothers and sisters become less likely: New parents’ drop in subjective well-being helps to explain why many remain with one child, even though they desire two. ScienceDaily. Retrieved August 3, 2023 from www.sciencedaily.com/releases/2015/08/150805075245.htm

O’Brien, A. P., McNeil, K. A., Fletcher, R., Conrad, A., Wilson, A. J., Jones, D., & Chan, S. W. (2017). New Fathers’ Perinatal Depression and Anxiety-Treatment Options: An Integrative Review. American journal of men’s health, 11(4), 863–876. https://doi.org/10.1177/1557988316669047

Paulson, J.F., & Bazemore, S.D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA, 303 19, 1961-9.