Post-adoption depression

A condition hard to understand: post-adoption depression

VANCOUVER — From Tuesday's Globe and Mail

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The minute she laid eyes on her adopted son, a seven-month-old Guatemalan boy, Michelle Brau knew something was wrong, she says.

Instead of joy, she felt dread. Instead of wanting to comfort the infant, she found herself not wanting him at all.

The negative emotions blindsided her, Ms. Brau says. She and her husband, Jim, had yearned to adopt and add to their family of four biological kids.

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"I love children," says Ms. Brau, who lives in Springville, Utah.

But she couldn't bring herself to love her healthy new son, nor a second boy, aged 2, whom the couple adopted from Guatemala months later.

Ms. Brau says she assumed her affection for them would grow with time. For more than five years, however, she avoided their hugs and was more strict with them than with her other children, she recalls.

Consumed by guilt and shame, she told no one about her inability to bond with the adopted boys.

"I felt like a monster," she says. "I longed to be dead."

When she finally confided in her husband six months ago, he did some research online and concluded she had post-adoption depression, a condition being studied by researchers but not yet recognized as a psychiatric disorder.

According to adoption professionals, post-adoption depression can range in severity from a few weeks of the blues to a major depression that lasts months or longer. Like postpartum depression, it may bring intense feelings of anxiety and guilt, fantasies of running away, and suicidal thoughts.

Ms. Brau consulted two therapists, she says, but her feelings of desperation did not change.

So this spring - nearly six years after they adopted the Guatemalan children - the Braus contacted an agency to find them a new adoptive home.

"These boys deserve so much more than I can give them," Ms. Brau says, adding that her depression has lifted since the adoption was dissolved last month. "I feel like me again."

The Braus' case may be extreme but the potential consequences of post-adoption depression are recognized by a growing number of adoption professionals.

Left untreated, it can lead to the breakdown of the adoption, says Brenda McCreight, an adoption counsellor in Nanaimo, B.C. "I've seen it break up marriages too."

Post-adoption depression didn't have a name until 15 years ago, and it remains a new area of research. Early studies suggest it's "as prevalent, or more so, than postpartum depression," says Karen Foli, who co-authored The Post-Adoption Blues with her husband John Thompson, a child psychiatrist.

A study published last month in the peer-reviewed Journal of Affective Disorders found the rate of depression in women after adoption was about 15 per cent - the same rate found in women who have given birth.

Dr. Foli, a professor of nursing at Purdue University in West Lafayette, Ind., is partway through a study to assess whether the tools used to diagnose postpartum depression are valid to screen for post-adoption depression. Unlike mothers with postpartum depression, who have a biological explanation for their bleak mood, adoptive mothers cannot attribute their depression to a sudden drop in estrogen levels (although some researchers suggest that nurturing an adopted child may trigger hormonal changes).

"We desperately need to understand it more," she says.

The syndrome appears to be more common in women than in men, Dr. Foli says, since women tend to be the primary caregivers. Stress, sleep deprivation, lack of social support and a history of depression can put women at greater risk for post-adoption depression, according to experts in the field.

Also, many adoptive mothers have no parenting experience, notes Sandra Scarth, president of the Adoption Council of Canada. For a career woman who has enjoyed years of freedom, the demands of parenting can be a shock, especially if the child isn't attaching to her well.

"Suddenly she's home all day with a child who really doesn't like her very much," Ms. Scarth explains.

When depression strikes, adoptive mothers are often secretive about it. They feel pressure from family and friends to rejoice in the child they brought home after years of waiting, often at huge expense.

Most are reluctant to seek help from social workers, fearing the child may be taken away - an unlikely event, according to Dr. McCreight.

Nevertheless, an estimated 11 to 18 per cent of adoptions break down for various reasons during the probationary period (usually at least six months), according to American researchers, and about 2 per cent of adoptive families cannot cope after the adoption is finalized. In both cases, the child returns to child-welfare authorities and may be readopted.

As awareness of post-adoption depression grows, some agencies are addressing the syndrome in their pre-adoption training sessions. But people who long for children tend to believe it won't happen to them, says Dr. McCreight, who has adopted 12 times.

"We think we're going to be the most wonderful parents and we're going to form a family identity with no problem - and that's not going to happen."

The expectation of "falling in love" with a child at first sight may be unrealistic, according to Dr. Foli, since most relationships take time to blossom and mature.

But the guilt of not bonding with a child immediately can be "overwhelming," says Dr. Foli, who coped with depression after she adopted her daughter from India about 10 years ago.

For Dina Rodrigues, post-adoption guilt cut deep. She sank into melancholy and began to feel "really run down" a month after she brought her 11-month-old daughter, Sierra, home from China, she says.

Ms. Rodrigues had no problem caring for her daughter's physical needs, she recalls, but she worried she wasn't connecting with her emotionally.

"It's like you have this amazing, wonderful child and you can't really enjoy them," says Ms. Rodrigues, who lives in a suburb of Detroit.

Her anxiety intensified when her husband, Ashok, bonded with Sierra easily. "I just felt there was something wrong with me," she says.

Having suffered from depression earlier in life, Ms. Rodrigues says, she recognized the signs. Five months after the adoption, she saw a therapist and started taking antidepressants "for my daughter's sake."

When a parent gets depressed, it doesn't mean the adoption has failed, says Dr. McCreight. "It just means that you should get help, get it fixed and move on as a family."

Major depression requires prescription medication, she says. As well, a post-adoption counsellor can help parents find ways to get child care and emotional support.

After Ms. Rodrigues began treatment, her daughter fell ill with a stomach virus and wanted to be held by her day and night. The event marked a turning point in their relationship, Ms. Rodrigues says.

"I was able to be emotionally there for her, and I think she saw that."

That was two years ago, she adds, and they've had a close connection ever since.

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Warning signs

Experts say post-adoption depression shares symptoms with postpartum depression:

Feeling sad, tearful, irritable

Self-imposed isolation from family, friends, spouse

Anger at the adopted child, spouse or other children for no apparent reason

Desire to leave home or have the adopted child removed

Loss of interest or pleasure in most activities

Significant changes in appetite and sex drive

Insomnia or a marked increase in sleep

Fatigue, lack of energy

Feelings of worthlessness or guilt

Thoughts of suicide

Adriana Barton

Follow on Twitter: @AdrianaBarton