When Depression Doesn't Look Like Depression | Dr. Becky and Dr. Chris Choukalas

What does depression look like? It's not always sadness. It can be anger. Irritability. Picking fights. Checking out. Taking risks that don't make sense. It can look, to everyone around you (including you), like a character problem, not a medical condition. Dr. Becky sits down with ICU physician Christopher Choukalas, who developed every symptom on the paternal postpartum depression list six months after his twin daughters were born, and had no idea what was happening to him. They also cover why this form of depression is so easy to miss, what it costs the whole family when it goes unnamed, and what getting help actually looked like for one father who needed it badly. Chapters 0:00 – Intro: the postpartum depression checklist 2:19 – Six months in: chaos, twins, and a traumatic birth 14:54 – Going through the symptom checklist 28:32 – Finding the right therapist 39:48 – Therapy vs. medical help: why the type matters Want more support navigating the moments that test you as a parent? Good Inside gives you the tools and community for that: https://www.goodinside.com/?utm_source=youtube&utm_medium=social&utm_campaign=traffic_evergreen&utm_content=description_20260717 Christopher G. Choukalas, MD, MS is the author of Even the Darkest Night: A Father's Journey of Hope and Healing from Paternal Depression: https://www.penguinrandomhouse.com/books/780237/even-the-darkest-night-by-christopher-g-choukalas-md/ Thank you to our partners for making this episode possible: SmartyPants: Shop SmartyPants Vitamins at Target, Walmart, or Amazon today LMNT: Get a free gift with your purchase at drinkLMNT.com/goodinside Girl Scouts: If you have a daughter in kindergarten through 12th grade, visit girlscouts.org to learn more Little Spoon: Get 50% off your first order at littlespoon.com/rattled with code RATTLED #goodinside #drbecky #postpartumdepression #paternaldepression #newdadlife #mentalhealth #parenting

Christopher ChoukalasguestDr. Beckyhost

Aug 4, 202641mWatch on YouTube ↗

EVERY SPOKEN WORD

40 min read · 7,920 words

0:00 – 2:19
Intro: the postpartum depression checklist
1. CCChristopher Choukalas
  After 10, 12 hours of work, I would start to think, "Okay, well, what's going on at home? Is it gonna be chaos when I get home?" And inevitably, I would have to take the long way home, and that would involve twisty, curvy roads. I have a old manual transmission car that can go fast and do dangerous things, and man, I was in it. And so for those four or five seconds where you were going so fast and turning so hard that you couldn't help but be immersed in that, there was this, like, release.
2. BEDr. Becky
  Hmm.
3. CCChristopher Choukalas
  But inevitably, the curve straightens, and your focus turns back to what you're gonna find at home.
4. BEDr. Becky
  So on the surface, this is an episode about a dad who experienced depression in the months after his daughters arrived. But honestly, I want you to hear this in such a broader context. The more we understand about how our minds work, the more we understand about what's actually going on underneath behavior, whether it's for us or a partner or someone in our life we really care about, the more behavior starts to make sense, and not make sense like it's okay, but make sense in that we actually understand what's going on, and then we can actually intervene in a way to make things better. And I just know by the end of today's conversation, you're gonna have that new framework. It's like you're gonna have a new set of glasses. You're gonna see things differently, and you're going to feel so much more empowered. Today, I'm talking to Chris Choukalas. He's a physician. He treats patients at an ICU at UCSF, and he's a dad who experienced this form of depression. Now, this form of depression doesn't just happen in men. It can happen in women as well, and it is eye-opening to hear him talk about all the different things that actually were part of his depressive cycle that were massively impacting his partnership and his relationship, or his struggle to really form a strong relationship with his daughters. And I have a feeling it's going to help you just to understand that this exists, that it's real, and that it can get help. I'm Dr. Becky. This is Good Inside.
2:19 – 14:54
Six months in: chaos, twins, and a traumatic birth
1. BEDr. Becky
  So it's six months after your daughters are born. What's, what's life like in your house?
2. CCChristopher Choukalas
  Well, at six months with twins, you can imagine there's a lot of chaos, but the truth of the matter is the chaos started even before-
3. BEDr. Becky
  Hmm
4. CCChristopher Choukalas
  ... that point. Uh, when the girls were born, you know, we're in the middle of COVID, uh, pre-vaccine. Uh, I'm an intensive care physician at the University of California, and so I'm seeing some horrific things, uh, every day at work.
5. BEDr. Becky
  Mm.
6. CCChristopher Choukalas
  And then on top of that, there are, uh, wildfires making the sky gray and orange and black and even the scent infiltrating the hospital as the girls were born. Lindsay's recovering from her emergency surgery, her harrowing near-death bleeding event, and I'm just kind of holding on. I, I don't think I know at the time what's happening. I'm just trying to be there and be present as much as I can.
7. BEDr. Becky
  Just show up, survive, function, keep the day moving forward, or how would you term it?
8. CCChristopher Choukalas
  Well, you know, I'm a, a, a, an earnest Midwestern Scandinavian-
9. BEDr. Becky
  Hmm
10. CCChristopher Choukalas
  ... and our job is to keep the train moving.
11. BEDr. Becky
  Mm-hmm.
12. CCChristopher Choukalas
  And so-- And as, again, as you can imagine, there's a lot to do. So I am shuttling the girls back and forth between the nursery and the ICU-
13. BEDr. Becky
  Mm-hmm
14. CCChristopher Choukalas
  ... where Lindsay's being cared for, trying to help with the feeding. They even, uh, have me carry these little swabs of, of colostrum from the ICU down to, uh, uh, down to the babies to-
15. BEDr. Becky
  Hmm
16. CCChristopher Choukalas
  ... pretend that I'm doing something that's helpful.
17. BEDr. Becky
  [chuckles] And, and give a little bit more color about, you know, about Lindsay's birth-
18. CCChristopher Choukalas
  Well-
19. BEDr. Becky
  ... story
20. CCChristopher Choukalas
  ... you know, we spent five years trying to get pregnant, and for anybody who's been through IVF, you know it's a lot of poking and prodding and tests. And because the pregnancy was so medicalized or, or the conception was so medicalized, she felt very strongly that the pregnancy and the birth would not be. We're in Marin County. There's a lot of home births. There's a lot of sort of non-traditional medicine practices there, and yet here I am trying to make sure that everything, quote-unquote, "goes okay."
21. BEDr. Becky
  Yeah.
22. CCChristopher Choukalas
  So I want every test, every ultrasound, and Lindsay did not. So we got to 39 and plus weeks with twins, which is-
23. BEDr. Becky
  Far along
24. CCChristopher Choukalas
  ... far along.
25. BEDr. Becky
  Yeah.
26. CCChristopher Choukalas
  Uh, and so when we finally went into the hospital, hours of failed induction strategies, ultimately a C-section, during which, as the babies are coming out, I'm realizing that Lindsay's blood pressure is dangerously low. And the, the, the cognitive disconnect between being an anesthesiologist who does care like this, uh, routinely, holding two babies that I've never-- I mean, I don't know that I'd ever held a baby in my life before that moment.
27. BEDr. Becky
  Yeah.
28. CCChristopher Choukalas
  And then simultaneously looking over my right shoulder at the monitor and realizing that something seems wrong, and yet they have not taken these babies from me and shuttled me out of the room, which is the first thing you do when something is going wrong in a C-section. And so after what felt like hours of, of, of just living through that, that sort of bewildering confusion, I, I sort of looked up over the drapes and realized what was really going on, that her uterus was bleeding from uterine atony, that the anesthesiologist and the surgeon were calling all of these plays to try to rescue her. Massive transfusion protocols. The machine that pumps and heats gallons of blood at a time to transfuse to her. Extra IVs being put in. And that's when I kind of snap to and realize, "I need to give them these babies, and I need to get out of here because I cannot help."
29. BEDr. Becky
  Yeah. That was-- That's the start of your, your fatherhood journey.
30. CCChristopher Choukalas
  The start of my fatherhood journey.
14:54 – 28:32
Going through the symptom checklist
1. BEDr. Becky
  did you have it-
2. CCChristopher Choukalas
  Mm-hmm
3. BEDr. Becky
  ... or like, no, not that one. But then I want you to tell me a little bit in your day-to-day how it actually looked, 'cause I think sometimes there's a gap with what we think something will look like and then what it actually looks like.
4. CCChristopher Choukalas
  Honestly, that's such a great exercise.
5. BEDr. Becky
  Anxiety.
6. CCChristopher Choukalas
  Anxiety was thing number one, and I didn't-- I wouldn't have labeled it as such.
7. BEDr. Becky
  Yeah.
8. CCChristopher Choukalas
  I would have just labeled it as I'm being a responsible parent. [laughs]
9. BEDr. Becky
  Yeah.
10. CCChristopher Choukalas
  But I would be up at night. I, I described those physical jolts of electricity. Uh, I was even having palpitations-
11. BEDr. Becky
  Yeah
12. CCChristopher Choukalas
  ... and had to see a cardiologist. Like, why do I have this irregular heartbeat?
13. BEDr. Becky
  Yeah.
14. CCChristopher Choukalas
  And, uh, and so a- anxiety, absolutely.
15. BEDr. Becky
  And, and just to go further on that, I mean, anxiety gets such a bad reputation, right? Like, anxiety is trying to be helpful. Just to say, you know, to everyone here, anxiety is trying to be helpful. Anxiety increases our alertness because our body thinks there's something in our environment that requires extra attention, which by the way, when you have a baby, this is true, okay? [laughs] So if someone said my anxiety level before I had twins and my anxiety level after I had twins, straight line. I said-
16. CCChristopher Choukalas
  Mm
17. BEDr. Becky
  ... I'd be, that's a little concerning, like, you know? [laughs]
18. CCChristopher Choukalas
  But you know, every time I would be confronted with something that I didn't like in this process, that burning and that pang of, of, of sensation, that's not normal.
19. BEDr. Becky
  Well, I think that's, that this is exactly kind of some of the nuance. So do I wake up sometimes thinking, "Oh, have I fed my baby recently?" That's, yeah, you wanna wonder that. You don't wanna sleep through the night and miss setting, you know, your alarm or responding to their cries, right? But what you're differentiating also is things felt like a 10-alarm fire.
20. CCChristopher Choukalas
  Every time.
21. BEDr. Becky
  Every time.
22. CCChristopher Choukalas
  Every time.
23. BEDr. Becky
  A- and, and then your body just kind of probably gets short-circuited into that more and more often.
24. CCChristopher Choukalas
  And the more tired you get, the more-
25. BEDr. Becky
  Exactly
26. CCChristopher Choukalas
  ... often it happens.
27. BEDr. Becky
  Does not help.
28. CCChristopher Choukalas
  And then it generalizes to lots of other things that are not threats, if you wanna think of it that way.
29. BEDr. Becky
  That's exactly right. Okay. Panic attacks.
30. CCChristopher Choukalas
  I had those, and they would manifest in the form of the rapid-fire cycling of if this, then that, then this, then that, and if not this, then not that.
28:32 – 39:48
Finding the right therapist
1. BEDr. Becky
  yeah, h- tell me about how did that, how does that all go?
2. CCChristopher Choukalas
  Well, uh, I, I had had some exposure to different models of therapy-
3. BEDr. Becky
  Yeah
4. CCChristopher Choukalas
  ... as a grad student in psychology, so I kind of knew what type of therapist I was looking for, like what sort of model, right?
5. BEDr. Becky
  Mm-hmm.
6. CCChristopher Choukalas
  Uh, I knew I couldn't have, like, a cognitive behavioral therapist 'cause I'm just, I'm already too up in my head. I needed to have somebody that was gonna take my words and turn them into feelings and basically spit them back in [laughs] my face and make me feel these things. But, but that isn't on the webs- I mean, they don't say, like-
7. BEDr. Becky
  They don't
8. CCChristopher Choukalas
  ... that's what I'm gonna do. So we, you know, and when I say we, I mean it was a family affair. It was Lindsay. It was Lindsay's sister. It was me. We were online, like, finding websites. And, and, and Lindsay's sister, who, who actually, she has a great sense of people. Uh, she was the one that introduced us and set us up. She found this guy, and she, and you'd ask her now, she'd say, "Well, you know, his face looked really warm on the website." But, uh, you know, people have these senses of things. There had to be more to it than that. And we had our, you know, introductory phone call, like, on a Tuesday, and I'm, I'm sitting on the stoop in front of our house and, or in front of our flat, and I'm just like, at, in about five seconds of talking to this guy, I'm just unleashing just sobs of like-
9. BEDr. Becky
  Hmm
10. CCChristopher Choukalas
  ... this is terrible, and I need to not feel this way.
11. BEDr. Becky
  It... I'm just thinking about, um, how the, how activated you were and angry and in threat mode, but then how much pain. It, there was a lot of... You realized in that moment I a- I'm actually, like, I'm in a lot of pain. You realized that?
12. CCChristopher Choukalas
  I think that it was so close to the surface-
13. BEDr. Becky
  Hmm
14. CCChristopher Choukalas
  ... that, like, one probing question, one, i- in a, in a setting that felt safe somehow- Just let it all burst out. I mean, you think of this stuff, a- and there's so many analogies where you're pushing it down or the pressure cooker and ah, the steam, but as soon as you open that cap, it comes out.
15. BEDr. Becky
  Yeah.
16. CCChristopher Choukalas
  And, and what does opening the cap look like?
17. BEDr. Becky
  Mm.
18. CCChristopher Choukalas
  A- and I think it's important to talk about this because a part of the whole point of the book is like to get guys into therapy.
19. BEDr. Becky
  Yeah.
20. CCChristopher Choukalas
  And, and a lot of men, I think, are afraid of what it's gonna be like 'cause they don't know and they don't wanna share feelings with a stranger. All these different tropes about like what it would be like to go. And, and for me, uh, th- there was just something about the way that he provided an environment that, that made me feel on some c- subconscious level that I could share these f- horrible, dark, awful things in the presence of another man without losing my masculinity.
21. BEDr. Becky
  Yeah. Mm.
22. CCChristopher Choukalas
  A- and that I could cry in front of this person, that I could be held metaphorically-
23. BEDr. Becky
  Yeah
24. CCChristopher Choukalas
  ... 'cause again, it's virtual, right? By this other man and not feel like less of a man somehow.
25. BEDr. Becky
  Yeah.
26. CCChristopher Choukalas
  And that's what opening the pressure cooker felt like, and it just came out.
27. BEDr. Becky
  Ca- can you give that a little more detail? Because for example, like I know, I don't know, again, I think, maybe we'll get back to this, there are so many different types of therapy-
28. CCChristopher Choukalas
  Mm-hmm
29. BEDr. Becky
  ... that sometimes, such a disservice in the psychology department because I think about if the medical department or someone say, "You need to go to a doctor," and you like go to a dermatologist when you actually needed an oncologist, like you'd be like, "That doctor was awful." Like, no, you just don't-
30. CCChristopher Choukalas
  Oh, that's super interesting. Of course they were awful.
39:48 – 41:25
Therapy vs. medical help: why the type matters
1. BEDr. Becky
  you end up in a dermatologist appointment. Well, that dermatologist could be the best dermatologist in the world, but it's not going to help you if you have an issue that dermatology isn't equipped to help you with. Therapy is often confusing for people because it feels like a black box, and there are people trained in very, very different ways, and most of the time we don't even know that. You might have just heard that for the first time. There are so many ways to get educated about this. Like I said in the conversation, there are probably good questions you can ask to the internet to get more information. But also, when a friend says to you, "I had a great therapist," you can ask that friend, "Hey, do you know what kind of therapy that therapist practices? I'm trying to learn more about this." Or if you're referred to a therapist, feel free on the phone to say, "Hey, I'm just learning that there's many different type of therapies out there. Could you tell me a little bit about how you were trained and how you tend to work? I'm trying to make sense of the right modality." You are definitely allowed to be an informed consumer. I would say you should be an informed consumer. You're about to share a lot of your life with someone and be vulnerable enough and brave enough to get help, and so please do ask those questions. All right. Let's end the way we always do. Place your feet on the ground, place a hand on your heart, and let's remind ourselves even as we struggle on the outside, we remain good inside. [Instrumental music] I'll see you soon.

Episode duration: 41:45

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