'Regret, Panic, and Loneliness': The Women Battling Post-Adoption Depression

Greene says when they adopted their son in 1999 they had never heard of post-adoption depression; it wasn't till much later that she came across the term. Similar to the symptoms of post-partum depression, parents who experience post-adoption depression—and it can be either adoptive parent, though it's more common in mothers—may feel despair, anger, anxiety, panic, guilt and fatigue. They may have sleeping problems, weight loss or gain, difficulty concentrating, feelings of worthlessness, and suicidal thoughts.

In the past, post-adoption depression was not recognised alongside post-partum depression (PPD) because, unlike PPD, there is an absence of hormonal changes as a result of birth. But research has shown that there is no significant difference in the incidence of depression between adoptive and birth mothers. According to a 2008 study looking at post-adoption depression among adoptive mothers, symptoms of depression were found in 15.4 percent of the study group, compared to 10-20 percent of all new birth mothers. Other estimates of parents experiencing post-adoption depression are variable, ranging from 10 to 32 percent.

And while it shares some similarities, post-adoption depression has its own unique characteristics: Some newly adoptive parents report that bringing a child home reignites feelings of grief, loss and unresolved infertility issues, and they can experience fear around mutual bonding and the challenges of parenting a child who may be traumatized—in addition to the stresses of the adoption processes itself. Parents may also be dealing with feelings of deflation and disappointment following adoption, not dissimilar to the letdown some people experience after the accomplishment of a major life goal.

"All in all, my deepest panic and depression lasted about three weeks. They were, at the time, the longest three weeks of my life," says Greene. Medication, time and wise counsel were among the things that helped. "My close friend said: 'Just fake it. He won't know you're faking it. Your faking it is the sweetest mothering he's ever known.' So I tried to not think, not feel, and fake being a loving mother to the child. The mothering actions themselves—bathing him, washing his hair, dressing him, feeding him—seemed to generate a mood of love when I wasn't looking."

Nazarov says that after a few weeks of "plummeting appetite, insomnia, lots of tears and obsessive fears about falling down the stairs holding the baby" she recognized she was depressed. Time, medication and a wonderful therapist, who was herself an adoptive mother, helped her work through her depression. Like Greene, she had never heard of post-adoption depression, and it wasn't until she came across Dr Karen J. Foli's book, The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption, that she had a name for what she was feeling—"What a gift that was."

Considered an expert on post-adoption depression, Dr Foli and her husband have two children by birth and an adopted daughter. The Associate Professor at Purdue University in Indiana, USA, has said she struggled with issues during the post-adoption period and this experience, along with a recognition that there was little information available about depression in adoptive parents, led her and her husband Dr John R. Thompson to write the book. Dr Foli, who has conducted a long-term study into post-adoption depression, has developed a theory that it is the expectations that parents hold of the post-adoption experience and the differences between those expectations and reality that creates stress and depression.

"Often, one strong expectation that is felt by adoptive parents is this notion of being a 'super-parent', which is neither realistic nor sustainable", she says. "Therefore, when a parent begins to struggle, it's difficult for them to admit this. Several parents have reported feeling like 'monsters' when they feel depressed, they have waited to be parents and see this as a life goal. They are utterly confused as to why they are feeling the way they are."

Dr Foli says that in addition to dealing with unrealistic expectations of parenthood, many adoptive parents also experience a lack of community support. "Often, because the mother doesn't go through a physical labor and delivery, friends, family and acquaintances may not see the needs of the adoptive parents."

Greene, an author, who wrote about her experience with post-adoption depression in her book: No Biking in the House Without a Helmet, says what would have been helpful at the time was "having the knowledge that such a reaction was not uncommon. Especially, as I later learned, in the case of the adoption of an older child who didn't enter your family as the first child." Greene advises women experiencing post-adoption depression to make contact with others who have survived the same thing. "Experiencing post-adoptive depression does not mean you've made a horrendous mistake and ruined everything. You may mostly be exhausted."

Her experience clearly didn't put her off, as she and her husband would go on to adopt another four children. Now, they have nine children ranging in ages from 34 to 19, and they are, she says, all "very, very close-knit and loving".

Recently, the US Preventative Services Task Force made a recommendation to screen mothers during pregnancy and postpartum for depression. Dr Foli has called for the recommendation to include adoptive parents before and after the placement of a child. "I want to emphasize that screening for, and treating, parental depressive symptoms benefits the entire family. Evidence is strong that for both birth and adoptive families, when a parent struggles with depression, children are at risk for negative outcomes. So for everyone—the parents and their children—screening can help professionals intervene earlier with greater sensitivity."

Nazarov also wishes she had been told it was normal as a new adoptive mother to have sad, frustrated or let-down feelings when the long process of adoption ended. "Here I was thinking, 'Yay, it's over!' But the real work—and the real joy and satisfaction—of parenting was just beginning."

She believes there's still a long way to go in raising awareness of post-adoption depression. "Many APs [adoptive parents] will be broadsided by it. For the sake of their child—who had no say in the matter and at a minimum deserves one or more healthy, whole parents to meet their needs—they must be willing to admit they may need help. Ask for help: meal help, childcare reprieves, someone to listen. Recognize that new bio-parents are not expected to 'do it all', and neither are you."