Fathers Get Postpartum Depression Too, and It Doesn’t Look Like You’d Expect

Postpartum depression has a familiar public image: sadness, withdrawal, tearfulness. For new fathers, it often looks almost nothing like that. Brett A. Biller, Psy.D., director of mental health at the Audrey Hepburn Children’s House at Hackensack University Medical Center, says paternal postpartum depression tends to show up as irritability and aggression instead, externalized symptoms that are easy for fathers, partners and even clinicians to misread as something other than depression.

The Educated Patient spoke with Biller about the specific hormonal shifts behind that difference, why the risk for fathers tends to build gradually rather than peak right after birth, and Hackensack Meridian’s new Productive Parent Coaching program designed specifically for fathers and father figures.

Why paternal depression looks different

Biller said the stereotypical picture of depression — sadness, melancholy, pulling away — reflects internalized symptoms. In fathers, depression more often externalizes as irritability and aggression. That distinction changes how people respond to it. “When people pull away, it’s easier to lean in toward [them], it’s easier to lean in and to provide support,” Biller said. “When people are aggressive, they’re externalizing, [and] we tend to pull away instead of leaning in to support.” Cultural expectations compound the problem, Biller said, since men are often expected to remain the family’s provider and source of strength, making it harder to accept help even when they need it.

A hormonal “perfect storm”

Biller described a specific hormonal shift behind the increased risk: rising cortisol, the hormone tied to fight-or-flight awareness, combines with falling testosterone, which helps regulate mood and energy, and rising estrogen, which increases empathy. “At the time that we have increased cortisol...our typical neurotransmitters and our hormonal pieces that enable us to regulate our mood and our energy are decreasing, yet our empathy is increasing, creating more of a sensitivity,” Biller said. That heightened sensitivity is appropriate for caregiving, he said, but combined with reduced mood regulation, it increases vulnerability to depression.

Why risk builds instead of spiking right away

A 2026 study from Karolinska Institutet in Sweden, published in JAMA Network Open, helps explain the pattern Biller describes. Researchers tracked more than 1.1 million fathers and found that the risk of a new psychiatric diagnosis actually dropped during a partner’s pregnancy and the early postpartum months, compared with the year before conception. But diagnoses for depression and stress-related disorders rose by more than 30% toward the end of the first postpartum year.

Biller compared the dynamic to a stretching rubber band: External stressors keep increasing after birth while a father’s capacity to manage them keeps decreasing, until something eventually gives. “It’s kind of like a rubber band that is under stress that continues to get stretched and continues to get stretched, eventually snaps,” he said.

A father-specific support option

That dynamic shaped Hackensack Meridian’s Productive Parent Coaching program, which Biller said began as a general caregiver support group aimed at reducing stress-driven reactions in the home. Fathers in mixed-gender groups began asking what a father-only version might look like, and Biller said research confirmed fathers want that kind of structured, professional-guided support, even if they’re less likely to seek it on their own. The result is a free, six-week virtual group specifically for fathers and father figures, including grandparents and uncles. The broader Productive Parent Coaching program also offers English- and Spanish-language groups, both virtual and in person, through partnerships with New Jersey school districts, the YMCA, and Head Start and Early Head Start programs. Groups run on a rolling six-week basis and are open to participants outside New Jersey through the virtual option.

The core message

Biller said allowing space for frustration and difficult feelings, rather than treating them as parenting failures, is central to the program’s approach. “If we allow a place for it, if we recognize it, that allows us to manage how we go forward in addressing those concerns and makes you a better caregiver,” he said.