Post-Adoption Depression: What to Know About PAD in Adoptive Parents

What Is Post-Adoption Depression?

Adoptive parents go through a lot to be able to adopt a child and when they finally have a child, they sometimes think the difficult parts are over; however, they can become depressed when the reality of meeting the child’s needs hits them, says Aimee Daramus, PsyD, a licensed clinical psychologist and author of “Understanding Bipolar Disorder.”

This is known as post-adoption depression or PAD; however, unlike postpartum depression, which has gained awareness over the years, post-adoption depression still remains underrecognized. In fact, Dr. Daramus explains that post-adoption depression isn’t a formal diagnosis like postpartum depression is.

While there are some similarities, postpartum depression doesn’t accurately reflect the needs and challenges of adoptive parents, says Dr. Daramus. “A lot more inclusion is needed so that there’s as much information out there on post-adoption depression as there is about postpartum depression.”

Signs of Post-Adoption Depression

Post-adoption depression can have a wide range of symptoms. While it’s normal for new parents to feel tired and worried, these are some of the signs that could be indicative of post-adoption depression, according to Dr. Daramus:

• Extreme fatigue
• Insomnia
• Lack of appetite and difficulty eating
• Feelings of insecurity and inadequacy
• Inability to function on a daily basis
• Excessive self-criticism
• Feelings of guilt and shame
• Numbness or inability to experience a full range of emotions
• Desire to isolate oneself and avoid reality

Causes of Post-Adoption Depression

These are some of the potential causes of post-adoption depression, according to Dr. Daramus:

• Parenting responsibilities: New adoptive parents can feel insecure and inadequate when the reality of their new responsibilities hits them. 
• Identity conflict: Adoptive parents may sometimes experience an identity conflict and struggle to take on the role of parent. Having hopes or expectations about their relationship with their adopted child that go unmet can contribute to these feelings.
• Unsupportive family or friends: Adoptive parents may worry about how their loved ones will react to a child who isn’t a blood relative. Some family members or friends may in fact be unsupportive of their decision to adopt a child, which can lead to stress and conflict in their relationships.
• The child’s needs: Adoptive parents have to contend with the child’s physical and emotional needs around the adoption, as well as any health or mental health issues the child has.
• Bonding and attachment issues: Adoptive parents and children may have trouble bonding, or bonding may take a longer time than initially expected. A child may also have an insecure attachment style, showing an initial disinterest in the adoptive parent.
• Unrealistic expectations: Adoptive parents may have an unrealistic idea of what the transition period will be like, setting them up for disappointment when things aren't how they imagined.
• Lack of support system: Adoptive parents may not have people with whom to confide their fears and concerns, causing them to feel isolated.

Diagnosing Post-Adoption Depression

Post-adoption depression isn’t recognized as a health condition yet, so it is often diagnosed as depression, says Dr. Daramus.

If you think you or a loved one may have post-adoption depression, you should reach out to a healthcare provider. They can offer treatment options or refer you to someone who can.

“A therapist, clinical psychologist, or psychiatrist can give the diagnosis and make treatment recommendations. Ideally, it should be someone who has experience with adoption-related issues,” says Dr. Daramus.

According to Dr. Daramus, the diagnostic process typically involves a long interview that may cover the following aspects:

• Symptoms
• Family history
• Medical history (which can help rule out other causes, like low thyroid levels)
• Impact of the condition on daily life and relationships

Treating Post-Adoption Depression

Below, Dr. Daramus outlines some treatment options that can help if you’re experiencing post-adoption depression.

Medication

Medication is an option and whether it’s required can depend on your condition. Medication can be prescribed by a psychiatrist, psychiatric nurse practitioner, or in a few states, a prescribing psychologist.

Therapy

These are some forms of therapy that may be helpful:

• Cognitive behavior therapy (CBT), which would focus on your beliefs about yourself, others, and the problems you’re having, and look at healthier choices for managing it all. 
• Dialectical behavior Therapy (DBT) can help with mindfulness and managing strong emotions, as well as some relationship skills, if that would be useful.
• Family counseling can help identify and heal family conflicts.

Interpersonal psychotherapy (IPT) is another type of therapy that may be helpful for adoptive parents. IPT is a form of therapy lasting 12 to 16 weeks and its main goal is symptom relief.

An IPT therapist tends to be fairly direct and active in the treatment, and they will help to make insights regarding the sources of a new adoptive parent's distress. IPT is based on the premise that postpartum distress is rooted in four “problem areas”: 

1. Grief: Acknowledging the losses that occur to an adoptive parent's sense of self, changes in their relationships, or more specific loss
2. Role transitions: Understanding life stage transitions and social transitions including the loss of an adoptive parent's independence and the changing of their social networks
3. Interpersonal disputes: Disputes that frequently occur after the addition of a child to the family including unmet expectations and intimacy struggles within partnerships
4. Interpersonal deficits: Looking at struggles with attachment in other relationships that may be causing distress

Psychoeducation may also benefit new adoptive parents. Psychoeducation is a type of educational therapy that uses elements of CBT and group therapy.

Its goal is to inform a person about their condition, manage their expectations, and normalize their experiences. Family members are often invited to psychoeducation sessions to become educated on their loved one's condition and support their journey.

Support Groups

Community support can be extremely helpful at this time. If you’re not sure how “normal” or “healthy” your reactions are, your best resource is probably a community of other adoptive parents to help you normalize your experiences and gauge if you need more help.

Other adoptive parents can help validate your feelings and experiences and offer practical suggestions for daily problems, as well as connect you with other resources that can help you.

Coping With Post-Adoption Depression

These are some strategies that can help you cope with post-adoption depression:

• Understand that your emotions are normal: You may feel guilty for feeling anything but happiness when you finally bring your child home, or feel ashamed about not being able to cope as well as you'd hoped. However, it’s important to understand that it’s normal for adoptive parents to experience complicated feelings after the adoption.
• Accept imperfections: During the adoption process, you may have built up certain expectations of yourself as a parent, or of your child and your relationship with them. These expectations of perfection can be difficult to live up to. It’s important to accept your own humanity and limitations. 
• Seek support: Seek the help of friends and family, and share your thoughts and worries with them. They can help you cope and offer support. Parenting isn’t easy and you’ll need all the help you can get.

A Word From Verywell

Post-adoption depression is not a recognized mental health disorder; however, it’s very real. Adoptive parents may struggle with the day-to-day reality of raising a child as well as several other challenges, including the stigma around adoption.

Connecting with others in the same circumstances can be helpful, as they can help provide advice, resources, and emotional validation. However, people who are struggling with severe depression, or experiencing suicidal thoughts, should seek help immediately, says Dr. Daramus.