The "Blues" Can Surprise Even Adoptive Parents

Karen Foli, Ph.D., and John Thompson, M.D., are co-authors of the book The Post-Adoption Blues. Dr. Foli, a registered nurse, and her husband, John R. Thompson, a psychiatrist, have two children by birth and are themselves adoptive parents.

Dr. Foli, who is on the faculty at Purdue University, interviewed 21 adoptive parents about their adoption and depression experiences following the adoption, as well as 11 experts, professionals in the field of adoption. The adopted children's range of age at placement was newborn to 12 years—the research was conducted when the children were between 12 months to 24 years respectively. Foli's findings were published in the March issue of the Western Journal of Nursing Research.

According to Dr. Foli, "Many adoptive parents spend their time during the adoption process demonstrating they are not only going to be fit parents, but super parents, and then they struggle with trying to be the world's best parent when the child is placed in the home... Adoptive parents also may experience feelings about their legitimacy as a parent, or even surprise if they don't readily bond with the infant or child."

Dr. Foli took some time out to answer some questions about depression following an adoption.

Meredith: What are some signs of post-adoption depression that may not seem obvious to new moms and dads? What are the most obvious signs?

DR. FOLI: The signs of postadoption depression are clinical signs of depression. According to the Diagnostic and Statistical Manual (Fourth Edition), the book that professionals use to diagnose individuals, the signs and symptoms of depression include*:

• A depressed mood; feeling sad or empty
• Loss of interest or pleasure
• Significant (unintended) weight loss or weight gain
• Difficulty sleeping or wanting to sleep all the time
• Feeling like you can't sit still/restless, or feel like you're slowed down/can't physically get going
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Diminished ability to think or concentrate or indecisiveness
• Recurrent thoughts of death or thinking about suicide/acting on these thoughts

*Five of the nine symptoms above should be present for the past two weeks and at least one of these five symptoms should include depressed mood or loss of interest or pleasure.

That being said, there might be other problems such as difficulty bonding with the child and the "typical" transition to parenting might be prolonged and exaggerated. There might be feelings of anxiety and even a "panic" that could be related to depression or other mental health issues.

Meredith: Can dads experience this post-partum/adoptive depression as well?

DR. FOLI: Yes. The literature supports that there are "sad" birth fathers. The research I have conducted which surrounds adoptive fathers also indicates that fathers may struggle with depression as well. The signs and symptoms of depression, however, might vary from the mothers. For example, fathers may be more disengaged, angry, frustrated, and cope by spending more time at work, etc. We still have much to understand about this area.

Meredith: What does treatment for PAD look like? What does it entail-and what can parents expect? Does it have to include medication?

DR. FOLI: The interventions to help alleviate depression with adoptive parents are very individualized. For example, one mother who took great pleasure in her career was advised to stay home with her baby daughter and take an extended leave from work. This mom was also exhausted emotionally after the adoption process. But what was highly valued in her life had been disrupted. She eventually found a good therapist that she could talk with and secured the services of an excellent daycare for her daughter and returned to work. She rebounded from her depression, bonded with her child, and was able to heal. It took a lot of work on her part, and finding a therapist who was "adoption smart" wasn't easy. But she did it.

Meredith: Do babies pick up on the mom's depression? How would a parent recognize this-and what should a parent do?

DR. FOLI: I think the question is really: What are the outcomes for a child who has one or both parents who are depressed? We know from the postpartum literature that there are significant negative outcomes experienced by children who have a depressed parent(s). There has been one study with adoptive parents as well and we find similar effects. Indeed, one could argue that children who are adopted are more vulnerable and are experiencing a tremendous adjustment period. Parental depression's effect on the child is an important reason to find effective treatments for the parents and why I can't emphasize to parents enough that by helping themselves, they're helping their children and families.

[If you believe you are suffering from postadoption depression, or know someone who might be, please contact your family physician or adoption agency (or both) for a referral to a qualified and licensed therapist who specializes in treating depression for the parents and the family.]