Post-Adoption Depression

How to manage this difficult side effect of a happy event

by Amanda MacMillan

When Lori Holden and her husband realized they couldn't have children, they turned to adoption. They first adopted a baby girl in 2001 and two years later welcomed a boy "to complete our family," she says. But with her second baby, things were harder. Lori worried that she wasn't bonding with her new son the way she had with her daughter, and she felt constantly overwhelmed and frustrated – with the baby and with herself.

Holden wondered if it was because she hadn't been present at her son's birth the way she had at her daughter's. Or because he was so fussy and neither of them were sleeping well. Or maybe because this time she had her hands full with a rambunctious toddler. "I was totally blindsided," says Holden, now 50 and living in Denver. "I couldn't feel grateful for these gifts, and I hated myself for it."

Holden sank deeper into despair, and when her son was about 6 months old, she reached out to the therapist who had helped her cope with infertility a few years earlier. "She realized right away that I was speaking in sweeping generalizations," says Holden, whose book, The Open-Hearted Way to Open Adoption was published in April. "Instead of saying, 'I'm upset with him because he won't sleep,' I was saying 'I'm the world's worst mother.' She realized that I was depressed and said, 'We've gotta lift you up out of this place ASAP.'"

Giving her feelings a name
A few months later, Holden found an article in Adoptive Families magazine about post-adoption depression syndrome (PADS). "It was the first time I'd heard the name," she says. "Finding out that I wasn't the only one, that there is a real phenomenon, was huge in helping me get better."

Although it's not as well documented as postpartum depression, PADS is not uncommon: In a 2012 study from Purdue University, between 18 and 26 percent of adoptive mothers (depending on the screening scale) reported depressive symptoms within the first year of bringing home a new baby or child. (Rates for the small number of adoptive fathers also surveyed were similar.)

Feeling tired was the number one predictor of depression among the moms studied, but study author Karen J. Foli, RN, says it's not clear whether fatigue contributed to the depression or vice versa. Other factors included unmet expectations of parenthood, the baby, and family and friends.

"These parents can spend years going through the adoption process and waiting for a child," says Foli, who coauthored The Post-Adoption Blues in 2004 with her husband. "To think that they might struggle once the baby arrives never even crosses their minds."

Many of the same factors that contribute to postpartum depression – lack of sleep, fussy babies, no time to yourself – can also cause post-adoption blues. And while adoptive parents don't go through the same hormonal and chemical changes as biological mothers, adoptive parents do have struggles unique to their own situation.

The pressure of perfection
"People assume that because you did not have this baby yourself, you can't possibly be going through the same emotional difficulties," says Kathleen Silber, ACSW, associate executive director of the Independent Adoption Center in Concord, California. "And with adoption, people feel like they have to be perfect, since they wanted so badly to rescue this child. They can't verbalize to family and friends that they're depressed or stressed out."

Residual emotions about infertility
For women who adopt after experiencing infertility, unresolved emotions can also contribute to depression, Silber says. "Not being able to have a biological child is a real, significant loss. You have to go through stages of grieving and truly let go of that invisible child before you can really move on to loving another child who wasn't born to you."

For parents who haven't fully coped with these issues, adoption can stir up emotions all over again. "They think they just need a baby to fix their problem, but instead of it being a magic cure, in fact it can be the opposite," Silber says. "That baby can be a constant reminder of your infertility: 'She doesn't look like me; I didn't give birth to her.'"

Adopting older children
Parents who adopt an older son or daughter may have their own set of unique challenges ahead of them. Jenni, 43, also from Colorado, experienced this when she brought a 10-year-old girl home from foster care. "She suffers from attachment challenges, and that has made it really hard for me to get close to her," says Jenni. "I'd always had this idea of what it would be like to be a mother and to have a daughter, and I had to readjust all of those hopes and dreams based on what she's capable of."

Jenni took her daughter's rejection hard and got them both into counseling right away. "It got to the point where I'd sit in the parking lot at work and cry because I didn't want to go home to her." For the first three years, she says, they fought on a daily basis. Now, with the help of family therapy and medication, their relationship has improved – and her depression, she says, is under control.

When to get help
Fatigue, lack of sleep, and irritability may be things that every new parent goes through – but they may also be signs of post-adoption depression. If you're often on the verge of tears, unable to enjoy the things that normally make you happy, or experiencing feelings of excessive guilt and helplessness, talk to a friend, counselor, or therapist about what you're feeling. And if you begin to think about death – yours or your child's – call your doctor immediately.

How to get help
If you're having trouble bonding with your adopted child or finding joy in what should be a happy situation – or you're worried about an upcoming adoption – these resources can help.

Reach out to your adoption agency. "A decade ago, the adoption community didn't really want to talk about the fact that adoptive parents might have problems like this," says Foli. "But the good news now is that agencies seem to recognize that support after adoption is necessary."

Find the right therapist. "It's important to talk to someone who's really adoption-smart, and who understands the unique dynamics of your situation," says Foli. A professional can also provide you with options, whether it's family counseling, medication, or just a shoulder to cry on.  Psychology Today's Therapist Finder tool lets you search online by state and specialty, including adoption. If you think infertility may be at the root of your problems, look for someone with experience in that area as well.

Meet like-minded parents. Support groups, both in-person and online, are important places to make connections with other adoptive parents who may be going through similar issues. Adoptive Families maintains a national database of support group for adoptive parents. You can also join the online community at forums.adoption.com.

Take some time off. Reach out to trusted friends and family members, and build up a support team that can give you a break from your parental duties, even if just for a few hours.

Rein in your expectations. According to the National Survey of Adoptive Parents conducted in 2007 and 2008, 13.6 percent of participants reported that having a child was more difficult than they ever expected. If you're considering adopting, be sure to speak with counselors about potential stumbling blocks along the way – both about parenthood in general and about you and your adoptive child's specific circumstances. And if you're already a new parent, give yourself a break. "We know it's not always easy and that sometimes, you need help," says Silber. "I wish more parents would tell us they're struggling, rather than keeping it all to themselves."

Take control. For Holden, it took a year of therapy and medication before she truly felt like herself again. But the turning point was when her therapist encouraged her to consider all her options: "The adoption wasn't 100 percent finalized, and she forced me to think about the scenario in which I would give my baby back," she says. "Once I did that, I realized that I actually had bonded with him – and that it was my choice to keep him. When I put myself back in control, things got better almost immediately."

It can be hard for parents to admit to themselves, and especially to others, that they're having a hard time with something they've wanted for so long. But if you won't do it for yourself, do it for the rest of your family.

"Getting help for yourself is going to help your spouse, and it's going to help your children," Foli says. "It's a very selfless thing to do."

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Amanda MacMillan

Amanda MacMillan

Amanda MacMillan is a freelance health and science writer who lives in Brooklyn with her husband and bulldog. Her work has been published on CNN.com and in Health, Shape, Prevention, Runner's World, and O, the Oprah magazine.

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