When we think about the stresses associated with pregnancy and giving birth, we usually focus our attention on the mother-to-be. We forget there is also a father-to-be.

Men can suffer from depression during pregnancy and, as surprising as it may seem, about 3 percent of fathers suffer from postnatal depression.

When it comes to pregnancy, men frequently feel left out. It is impossible to understand how it feels to carry a life inside oneself for nine months. Men can try to sympathize with their partners as the women experience the hormonal and physical changes that come with pregnancy, but they can never really experience the same thing. Men want to help, to make it better for their partner, but they don't know how.

Thoughts of impending fatherhood create stress during pregnancy. Research studies show that more than 60 percent of fathers feel some form of depression within the first four months after a baby's birth. While the birth of a baby is exciting and exhilarating, it brings about many changes all at once. These changes impact the entire family, not just the mother.

Roles change and responsibilities increase. Feelings of freedom may be in the past. Experiencing fear of the unknown during pregnancy is common for both women and men. Men and women differ, however, in the issues that occupy their thoughts before and after the baby is born.

For men, who are protectors by nature, the ability to support the expanding family financially and keep the family safe are frequent worries. Additional fears have to do with thoughts about harming the baby by accident; the health of the baby and wife; the unexpected loss of the wife and having to raise the child alone, and dying unexpectedly, leaving the wife and child alone. A new father may question what kind of dad he is going to be ? especially if he had a poor relationship with his own dad. This fear starts with the pregnancy and may continue through the early years of the child's life.

Once the baby is born, the reality of the situation finally sets in. There is a new person to consider. All of the nagging fears and doubts at the back of the mind during the pregnancy may come rushing to the forefront.

Men may minimize the importance of these thoughts and feelings, unfortunately. Discussions about male depression are still somewhat taboo. Many men think it is not "manly" to experience or express feelings of doubt and fear about being a father. Keeping these feelings inside and pretending they don't exist leads to increased stress, however, and puts additional strain on the family.

Understanding the various symptoms associated with postnatal depression will enable expectant and new fathers to recognize when a potential problem may exist. Symptoms include mood swings, anxiety, irritability, feelings of hopelessness and insomnia. It is also common to lose motivation, interest in activities and experience a loss of appetite. In severe cases, there may even be thoughts of suicide.

Unfortunately, these symptoms do not occur in a vacuum, and can affect those around the men affected ? including the newborn child. Studies have proven that maternal postnatal depression affects a child's development. New research indicates that boys whose fathers experience postnatal depression are twice as likely to have behavioral and emotional problems during their pre-school years.

While some level of mood change is to be expected after a birth, it is important to pay attention to the severity and frequency of depression symptoms. For men who have been experiencing any of the symptoms for 14 days or longer, the advice of a mental health professional is strongly advised. Early treatment can greatly minimize the longer-term consequences of male postnatal depression on the father, mother and child.

Spending time alone with the newborn, bonding with the child and caring for his or her needs can be valuable in creating a role for the father in the newly expanded family. Feeling left out is not unusual when the care of the child falls primarily to the mother. Both mothers and fathers are learning about parenting and baby care at the same time. It is important for a father to create an open dialogue with his spouse and share his concerns. The couple may find that each is experiencing the same fears.

For more information about postnatal or male depression, call Princeton House Behavioral Health, a unit of Princeton HealthCare System, at (800) 242-2550. To locate a University Medical Center at Princeton physician near you, call (888) 742-7496.

Jeffrey T. Apter, M.D., is board-certified in psychiatry and conducts clinical research for patients with depression. He is a senior attending physician at University Medical Center at Princeton.