New dad Kham Sirimanotham did all he could for his young family. When his wife was diagnosed with postnatal depression, it was up to him to do the shopping, make decisions and cuddle the baby when his wife was too ill.
With little family support, he juggled the intense needs of his wife and baby with his job as a civil servant. As the milestones passed and his daughter grew into a toddler, he found it increasingly hard to cope.
Anxiety gnawed at his stomach, he lost weight and became inert. "In my darkest days all I could think of was going to sleep and hoping it would go away," he says. "But then I couldn’t sleep."
Finally it clicked that he, too, was suffering postnatal depression (PND). Two years after his daughter was born, he visited the GP and was given antidepressants.
After a few weeks on medication he was feeling worse. As his symptoms worsened, his GP referred him to a psychiatric ward, where he spent three weeks learning to listen to what his body was trying to tell him.
Sirimanotham's experience is not unique: new research shows that men are just as likely to suffer from postnatal depression following the birth of a baby as women.
While one in 10 mothers suffer from PND, an Australian study published in the Journal of Social Psychiatry and Psychiatric Epidemiology shows that men are equally prone to the illness in the first year of the baby’s life.
But because PND is traditionally associated with womanhood, it is not picked up, or taken seriously, in men.
The study also shows that 30 per cent of fathers who have problems in the first year of their child’s life continue to report ongoing mental health issues.
According to Professor Philip Boyce, head of the Perinatal Psychiatry Clinical Research Unit at Sydney’s Westmead Hospital, fathers under the age of 30, and men who have suffered previous bouts of depression, are also at a higher risk.
"I don’t think people have recognised that men get depressed at this time," says Professor Boyce. "It is one of the things we should be looking for when we see women with postnatal depression."
While postnatal depression in men doesn’t contain a hormonal component, the same stresses that can trigger it in women - such as fatigue, isolation and poor social networks - can also affect men.
Traditionally, men have dealt with stress by drinking too much, working too hard and using a variety of other behaviours, such as gambling, as a means of alleviating their distress. "But that maybe changing as we encourage men to talk about their feelings," Professor Boyce says.
These days, organisations such as PANDA, beyondblue and the Melbourne charity Centre of Perinatal Excellence (COPE) promote awareness of postnatal depression in men. But more needs to be done, experts say.
Professor Boyce says employers need to cut new dads more slack, while Dr Nicole Highet, founder of COPE, has called for extending the screening of pregnant women for PND to include their partners, "given that we know that the husbands of [affected women] are 50 per cent more likely to develop it."
According to Howard Todd-Collins, psychotherapist and director of Melbourne-based Men and Relationships Counselling, what he would see as depression, some men talk about "in terms of feeling out of control, being more agitated or angry, or they may say they feel lost and want to hide or withdraw".
For Todd-Collins, depression in new fathers is often triggered by being emotionally unprepared. "A lot of the work I do with men is around emotional awareness that comes with things such as loss of freedom, lack of sleep, sex and so on ... all the things they took for granted before," he says. "Some dads just aren’t prepared and it becomes very difficult."
The internet is a good place to find help initially, says Boyce, with websites such as MoodGYM offering first-line treatment and strategies. "A very small minority of men may need some medication; the majority would benefit from counselling or cognitive therapy," he adds.
These days, Kham Sirimanotham is in a good place, and he says, "I eat well, I stay in routines. I do meditation. If I ever feel sad or depressed I take it seriously.
"It’s hard for guys because there is still a stigma around mental health, and you worry about being seen as weak. But I don’t care what other people think. I’m proud to say I had it, I got help and I’ve recovered. It feels like a real achievement.’’
PANDA MensLine: 1300 789 978
Lifeline 24-hour crisis support: 13 11 14