Post-Adoption Depression

These boys deserve so much more than I can give them
Six years after adopting two boys, Michelle Brau was still unable to
form a bond with them. Now they're in a new home. She may have
suffered a condition many still don't understand: post-adoption
depression
ADRIANA BARTON

VANCOUVER — From Tuesday's Globe and Mail, Tuesday, Jun. 09, 2009

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.

"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.

***

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