We Adopted a Beautiful Baby. Then I Got Depressed.

What women really think about news, politics, and culture.
April 3 2013 8:00 AM

My Post-Adoption Depression

It was as crippling as postpartum, and much less recognized.

Amy and Jake.
Amy Rogers Nazarov and her son Jake

Photo courtesy of Amy Rogers Nazarov

The vision always began the same way: I'd be leaving my house cradling my 9-month-old baby to my chest, his chin on my left shoulder, my right hand supporting his head, my left hand on his fleece-swaddled rump—and then I’d slip on the ice-crusted iron staircase. With the cold metal rushing up at us, a single thought would grip me: How do I protect him?

It had been a month since my husband Ari and I had brought Jake home, since I’d vowed to the governments of South Korea and the United States, as well as social workers in both countries, that I would do anything to keep this child we had adopted in Seoul safe from harm. For weeks, the imaginary accident had played like a film loop in my head; I’d break it down frame by frame, looking for places where I might regain control.

Among my preferred defensive maneuvers: Tuck his head snugly against my neck, leaving a gap for him to breathe into; quickly fashion the low-hanging end of the fleece blanket into a makeshift pillow, buttressing the padding already around him; pivot in midair so I'd land on my side, reducing the chances of crushing him. I might break my arm, but his tiny body would be cushioned by mine at the moment of impact. I’d only been a mom for four weeks, but I believed that this kind of detailed strategizing to defuse all possible threats was what all new mothers did.

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Ari and I had first met the baby in his foster family’s apartment in Seoul, where his foster mother, Mrs. Lee, had served us platters of absurdly large strawberries and baram tteok, a treat made of mashed rice cakes filled with a sweetened bean paste. But I couldn’t eat a thing.

I remember his unexpected warmth and heft when Ms. Park, our social worker, carefully placed him in my arms. I smelled his hair and admired his socked foot in the palm of my cupped hand. He regarded me with mild curiosity, gnawing on a blue plastic rabbit that dangled from his neck by a satin ribbon. “Bonding,” the thing I’d stressed about for months prior, as most prospective adoptive parents do, took about 90 seconds. My love for him was instantaneous and complete.

On Friday, we went to our adoption agency to take permanent custody of baby Jake. On Saturday, we boarded a plane to Washington, D.C.

Not 24 hours after crossing the threshold of our home with us, our son grew so listless I became alarmed and called the pediatrician, who hadn’t met him yet. He’d had a mild cold on the day we’d received him in Seoul; still, the on-site doctor deemed him well enough to travel. But when I described his pale complexion and tearless cries to our new pediatrician over the phone, she ordered us to the emergency room, warning that dehydration in babies was extremely dangerous. We’d been diligent about giving him his bottles, but he was indeed dehydrated, and while he came back to himself after receiving intravenous fluids, we were wrung out from fear, from the feeling that we’d missed some obvious sign of his distress.

More health problems stacked up over the next month, a fairly common phenomenon among children newly adopted from another country. Jake came down with bug after bug: gastroenteritis, conjunctivitis, a virus that kicked off a 104-degree fever. His large head alarmed the pediatrician enough that he ordered a sonogram to rule out hydrocephalus. Ari and I slept on the floor near his crib, argued in the dark over whether it was too soon to give him another dose of baby ibuprofen, entertained him with hand shadows as the technician wanded his soft spot looking for brain abnormalities (none were found). With each subsequent illness, I felt my worries compound into something more ominous—a mounting pile of doubts about my ability to parent. If I feel this helpless in the face of germs, how am I going to protect my child from bullies, racists, West Nile virus, climate change?

Around week four, my appetite waned. I started bursting into tears for no reason at all. Not only did I obsess about the icy stairs, but I became preoccupied with how to defend Jake from imaginary carjackers. I started practicing unbuckling him quickly from his carseat. I began missing work deadlines, ignoring calls from friends, wearing the same ratty black pants day after day. Sleep was strangely elusive: Even at the end of an exhausting day caring for this bright-eyed, sweet little man, whose smiles were coming more frequently, I’d lie awake in bed as if my eyelids were screwed into the open position.

Bed began to feel like the only safe place, in fact.

“Amy, I really, really need you to get up,” Ari would say over his shoulder as he carried Jake downstairs to where our gentle new part-time babysitter was waiting. “In a little while,” I’d answer vaguely, wishing I could just disappear beneath the sheets forever. Once or twice I reviewed in my mind’s eye the contents of the knife block in my kitchen, wondering whether a serrated or straight blade would be more effective at slicing open my wrist.

For the first time ever, I was depressed. And as far as I knew, there was no name for the state in which I found myself. I couldn’t, after all, call it postpartum. I hadn’t gone through the hormonal roller coaster of pregnancy and recovery. I hadn’t experienced labor and delivery, nor was I breast-feeding, which some adoptive parents successfully train their bodies to do. Moreover, I’d had a clean bill of mental health as we moved through the adoption process. (In fact, any history of a prospective adoptive parent’s using antidepressants or receiving counseling of any kind, whether or not it’s related to depression, can derail their chances of adopting a child from certain countries, South Korea among them.) Nevertheless, I was in the throes of an adoptive parent’s version of postpartum depression.

It turns out I was not—am not—alone. A March 2012 Purdue University study suggests that between 18 and 26 percent of adoptive mothers struggle with post-adoption depression, brought on by extreme fatigue, unrealistic expectations of parenthood or a lack of community support.

In the course of interviewing some 300 women who’d adopted one or more children in the prior two years, Karen J. Foli, an assistant professor of nursing at Purdue, says that she and her team—including Susan South and Eunjung Lim—began examining societal assumptions about adoptive parents. Among them: the belief that the mother who doesn’t carry a child for nine months or doesn’t go through labor does not require as much help after the child comes home, does not need respite care, or someone to unload the dishwasher, or a few casseroles in the freezer.

I had certainly assumed as much. I didn’t take maternity leave, feeling at some deep level that I neither needed it nor earned it. I kept up with my reporting and writing assignments, underestimating the importance of just rolling around on the floor with our new baby, who likely was grieving the sudden absence of his beloved foster mom.  I didn’t feel that I “deserved” as much help as my friends who’d given birth had received. I found myself questioning my authenticity as Jake’s mother. I’d look at Jake and think: This child came from another woman’s body. Who am I to say I am his mother?

“No matter what, there is time when the [adopted] child has lived apart from his or her adoptive parents,” says Foli, co-author, with Dr. John R. Thompson, of The Post Adoption Blues: Overcoming the Unforeseen Challenges of Adoption. “When he comes home, it adds to society’s impression that the adoptive parents are the ‘winners,’ as compared to the birth parents, who relinquished the child, and the child himself … There is this unspoken message that the adoptive parents are coming out [ahead] of all in the adoption triad, [so] there can be a stigma when you, the adoptive parent, struggle in your new role. This was your life goal, people say to adoptive parents. This was what you wanted.”

In other words, to complain that my new life taking care of this baby was much scarier and much harder than I’d ever thought it would be seemed obscene.

Yet just like some biological mothers, I may not have had a choice in how I felt. Dr. Lisa Catapano, an assistant professor of psychiatry at George Washington University Medical Center, told me that both postpartum depression and post-adoption depression are likely to be triggered by biological, psychological and social factors, and that there is more overlap between moms by adoption and moms by birth than one might first realize.

No matter how the baby arrived, new parents are contending with shifts in their identities and in their relationships with their partners. New parents struggle with feelings of inadequacy. Perhaps they lack relatives nearby to help keep up with food preparation or laundry duties, or find themselves leaning on friends more than they’d like as they adjust to this profound life change. And it’s all but guaranteed that no new parent is getting much sleep.

In addition, love at first sight is not always the norm whether you adopted the child or delivered her. “Just as people fall in love differently,” says Catapano, parents “bond at different rates with their babies.” While I felt strongly attached to our son the minute I first held him, I know other adoptive and biological parents who’ve told me, a little tentatively, that theirs was a more gradual process.

Another potential factor that could contribute to PPD or PAD: infertility. There is no question that the struggle with infertility that may have preceded the arrival home of an adopted child—or a pregnancy, for that matter—leaves its scars. “Some of my patients with fertility problems harbor a secret fear that they were not meant to be parents,” Catapano suggests. “If you came to adoption by way of infertility, the consequences of infertility don’t fully disappear when you have your baby, because there were all these losses that happened to you during a period of infertility. You don’t have a baby in the way you had planned to, or in the time you had planned to.”

While biological mothers’ fluctuating hormone levels are thought to play a part in PPD’s onset, depression after adoption, Dr. Payne found in a 2010 study “was much more likely to be associated with stress and with a perception of how difficult the [adoption] process was rather than a personal or family history of depression.”

How I wish I’d known about Dr. Payne’s and Dr. Foli’s work back when we first brought Jake home. Thankfully I recognized that something was deeply off kilter, that I needed help to get better and to get Ari help to care for our baby. I asked my parents to come stay with us, started Zoloft at my doctor’s suggestion, and got a prescription for sleeping pills to battle the hellish insomnia. Other eyes were on me then, too: I know now that our social worker, whom I’ll call Monica, who had conducted our pre-adoption home study back in 2007 and who had gotten to know both of us well, was closely monitoring our family.

When Monica would visit, I was scared that once she saw how weepy and tired I was, she would remove Jake from our custody. But my fears were unfounded. Though I had no name for what I was feeling at the time, Monica had suspected then that I was depressed, and she suggested I talk to my doctor. Years later, she told me that she never wavered in her belief that Ari and I were taking the right steps to ensure our baby’s well-being and to help me recover.

For the next six months, my therapist helped me explore my greatest fear: that I was not a good enough mom for Jake, who’d had no say about who would raise him and who over time would have his own adoption-related losses to grieve. I realized that my periods of greatest despair were driven by two key fears: that I would not be able to keep him safe, and that I’d be unable to help him make sense of how he came to us.

And then one day that fall, a curtain lifted. It wasn’t an hour or two of feeling like my old self, which I experienced around the sixth or seventh week of taking Zoloft. It was a whole day, and then another, and another, in which I felt prepared to meet Jake’s needs, in which I marveled at the way the autumn light hit the Potomac, in which I thanked the universe for bringing our family into being. The great and unexpected gift of my depression was the ability to appreciate more fully everything I might have lost.

Amy Rogers Nazarov is a writer in Washington, D.C. She is at work on a memoir of her experience with depression after adoption.