The Herald Banner, Greenville, TX

January 9, 2013

After adopting a baby, depression can hit

By Amy Rogers Nazarov
Special to The Washington Post

— In February 2008, my husband, Ari, and I brought home from South Korea our baby Jacob, whose adoption we had begun in 2006. Our first few weeks together were exhausting and wonderful but also scary as Jake came down with one illness after another — 104-degree fevers, croup, tummy troubles, you name it — and our pediatrician was concerned about his large head size and ordered tests to rule out hydrocephalus.

Weeks of sleepless nights later, I was feeling wildly unqualified to mother this beautiful stranger and wondering why parenthood was so much more stressful than I'd expected. I was also surprised to detect a flicker of hesitation about my authenticity as Jake's mother. Was he really "mine"? Was I up to this job?

By late March I had lost interest in eating or even getting out of bed. I burst into tears daily, upsetting Ari and Jake. I withdrew from the baby we'd longed for even as I was terrified that the social worker overseeing our post-placement period would take Jake away if I let on how awful I felt. What was wrong with me that I couldn't embrace motherhood as so many of my friends — both "bio" moms and adoptive ones — had done? I'd never been depressed in my life, but at age 39, I was now facing a full-blown bout.

Everyone has heard about postpartum depression, which can be triggered when hormones go haywire after a woman has given birth and is coping with the exhausting, round-the-clock demands of an infant. But new research has focused on what I unexpectedly felt four years ago: post-adoption depression. And it turns out it's not that uncommon.

A March study of 300 mothers by Purdue University researchers found that post-adoption depression syndrome, or PAD, afflicts between 18 and 26 percent of adoptive mothers in the first year after an infant or child is placed with them. With approximately 120,000 children being adopted annually in the United States, the Purdue report suggests that tens of thousands of adoptive mothers may be suffering from depression.

"When an adoptive parent struggles in adjusting to the new role of parenthood, she or he may hear 'But this was your life goal! You got what you wanted!' " says Karen J. Foli, an assistant professor at Purdue's School of Nursing and a co-author of the study along with Purdue's Susan South and Eunjung Lim.

Foli, who also co-authored the book "The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption," says that adoptive parents' unrealistic expectations, often sky-high after a long period of waiting to become a parent, can clash with the day-to-day demands of child care.

In fact, says Lisa Catapano, an assistant professor of psychiatry at George Washington University Medical Center, all new parents, biological or adoptive, contend with the same challenges that contribute to depression: "Sleep deprivation, a change in your relationship with your partner, a greater need for help from others, the stress of caring for a new baby, the change in your identity" and, for biological mothers, "hormonal shifts." While adoptive parents "may not have the hormonal changes," the other stressors are there, says Catapano, who treats both adoptive and biological mothers for depression.

For these reasons, PAD comes as a nasty surprise to some new adoptive mothers.

"Adoptive parents often have this sense that they are going to be a 'super parent,' " says Anne Pearce, director of adoption services with Baltimore's Board of Child Care, a private adoption agency. "But sometimes people are surprised or disappointed by some aspects of parenting: the exhaustion, or missing being in the workplace after looking forward for so long to being with a baby. I tell my clients, 'Whatever you are surprised by is no surprise.' "

Washington, D.C. resident Jenny Nordstrom, who had struggled with infertility before adopting daughter Sienna, now 5, remembers being stunned by how trying the early days with a baby could be, in unexpected ways. For example, she said, "My daughter's schedule was so different from those of other kids, so there we'd be at the park when no one else was. I am a really social person, and I felt so isolated." Yet after waiting so long to be chosen by a birth mom and then traveling out of state to be present at the delivery, "I remember thinking 'How can I be anything but overjoyed?' " says Jenny, 44. After two months, she sought treatment for depression but resisted trying antidepressants for another year. Eventually she did and began feeling like her old self.

Kim Severn Denny, of Auburn, Wash., had postpartum depression after giving birth to her son Quinn, now 8, yet she says she was unprepared when similar symptoms hit her after adopting her daughter Lauren nearly five years later. "I was in denial about my depression after adopting Lauren, because I thought 'I adopted her, I didn't deliver her,' " she says. A mental health counselor, a friend from church and her general practitioner all helped Severn Denny recover through a combination of counseling, dietary changes and keeping a journal of her emotions.

In my own case, anxiety about whether I was a "good enough" mother and about whether I'd be able to help our son navigate life in a world that will ascribe traits to him simply because he is Asian, coupled with worry about his nonstop sicknesses and the attendant deprivation, all set the stage for my depression. But it was only when I stumbled upon Foli's book one day at a bookstore that I began to understand why I was despairing.

Antidepressants, counseling and a husband, family and circle of friends who stuck by me, sometimes just to keep me company while I did little but stare at my uneaten lunch, helped me recover. That, and learning in time to trust my parental instincts.

Now, nearly five years after we brought him home, Jake is thriving and I feel at home in these maternal shoes. And while I wouldn't wish depression on anybody, temporarily losing my sense of hope about life made its return that much sweeter.

Amy Rogers Nazarov is a writer in Washington, D.C. She is working on a memoir about depression after adoption.