Having Surgery? What You Need to Know About Post-Operative Depression

Get well soon.

Balloons and cards offer--or sometimes command--this well-meaning sentiment to patients in the hospital. Gifts of stuffed animals and flowers are showered upon people to provide comfort and cheer. But for some patients, nothing can help them feel better after leaving the operating room. Even as they recover physically, their mental health suffers as they experience sadness, fatigue or anxiety--all of which are symptoms of post-operative depression, a commonly experienced but little-known condition. 
Depression following surgery is a frequent occurrence but not nearly as frequent a topic of conversation in the medical community. It can be credited to a number of physical factors after an operation, including reactions to anesthesia and narcotic painkillers, pain and discomfort, or an undetermined biological process. The type and severity of the depression can vary depending on the type of surgery performed, but according to HCPLive, post-operative depression is reported to occur more in coronary artery bypass graft (CABG) patients who smoke, are single, experienced anxiety before the surgery, have high levels of cholesterol and angina or more severe heart disease or are undergoing another CABG. Emotional triggers of post-operative depression can be credited to disappointment in the outcome of the surgery and a response to physical changes such as stitches or scars as well as resulting feelings of vulnerability and fear.

Experiencing anxiety before an operation is often not surprising to patients, but the feelings are not as easily explained after the procedure has been completed. Post-operative depression can be especially bewildering if it comes as a surprise to the patient because it has not been discussed between the doctor and patient.

Symptoms of post-operative depression vary with each person, but common ones include changes in appetite and energy levels, shifts in mood such as apathy or irritability, fatigue, and feelings of hopelessness and despair. The physical symptoms might also be credited to the after-effects of the surgery, which can make the diagnosis of post-surgical depression difficult and confusing.

Defined by the Mayo Clinic as a “medical illness that causes a persistent feeling of sadness and loss of interest,” depression is already a difficult topic for people to discuss, and many are reluctant to admit to feeling the way they do, thinking they have no reason to be depressed or are just going through a rough time at the moment. Factor in that many medical facilities do not screen patients for depression after surgery, as well as the fact that post-operative depression usually does not begin to show itself until after the patient has returned home from the hospital, and it can be difficult for family members and friends, as well as the patients themselves, to understand what is happening.

The topic of post-operative depression yields few medical or news articles online, but many blogs and message boards are filled with posts about the topic—both by people suffering from depression and from their loved ones looking for help and advice. Many people mention feeling helpless and unable to offer any advice or comfort to the people experiencing depression as well as failing to understand why depression is occurring after the surgery has been completed and the patient is recovering.

Along with loved ones, many physicians also find themselves unprepared for the emotional needs of their patients following a surgery. In the 2000 Harvard magazine article “An ‘Understandable’ Complication,” Theodore Stern, chief of the psychiatric consultation service at Massachusetts General Hospital said, “Many doctors don’t know the criteria, and don’t speak with patients long enough to establish whether they have the symptoms of depression. Sometimes, physicians believe that being depressed after surgery is ‘understandable’ and unworthy of diagnosis or treatment.”
According to Stern, depression is unrecognized 50 percent of the time by primary-care physicians. In the New York Times article “Facing Up to Depression After a Bypass,” Dr. Barry Wohl, a doctor who suffered from post-op depression after a bypass surgery elaborated on the disconnect between doctors and patients, saying, “As a physician, you tend to minimize what your patients are going through. You say it's temporary. Or we just don't deal with these kinds of issues.”   

Admitting to depression can be extremely difficult for people due to stigma over mental health. Sufferers may also fear being judged for experiencing depression after a surgery, especially if the surgery was successful and recovery is going well. However, dealing with depression in an upfront way is becoming more commonplace as the topic is discussed more openly.
In any given year, 15 million American adults have a major depressive disorder and the number of people for depression has increased substantially according to a recent Wall Street Journal article, which states in 2007 that approximately three out of every 100 people in the U.S. were treated for depression, compared to about two per 100 in 1997 and less than one per 100 in 1987. The “Depression” community on Facebook has more than 30,000 fans. In everyday conversation, people describe themselves as being depressed more frequently, especially as unemployment and financial troubles have become more and more common.

Patients experiencing post-operative depression typically recover within six months of the operation, but during those six months, they may need medical or psychological treatment and definitely need support. The treatment of post-operative symptoms may vary, but in all treatment, acknowledgment of the patient’s feelings is crucial. That's why discussion about post-operative depression should begin before the surgery. Patients should be prepared for the possibility before it happens so after they leave the operating room, they actually can begin to get well soon.

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