Depression after surgery is seldom discussed but is not uncommon, and is a normal reaction. Symptoms are manageable if addressed. The most important factor is “how well the patient is prepared to think and feel about the process.”1 The length and severity of post surgical depression directly relates to the type of surgery performed and the related recovery process. Counseling, medication, and consultation with physicians can help alleviate and treat surgically related depression.
If you’d like to speak with a therapist about how feelings of depression are impacting your life, click here. Find someone who understands the difficulties of recovering from surgery, someone who can offer support and who can help you develop healthy and effective coping skills. Meet with them online at a day and time that’s convenient for you. Getting started is free, easy, and confidential.
How Common Is Depression After Surgery?
The frequency of depression post surgery is connected to the diagnosis and the reason for surgery. If a patient has a pre-existing diagnosis depression prior to surgery they are at higher risk for experiencing depression post surgery. There are additional factors that increase the possibility of post surgery depression including chronic pain, changes in body image (breast surgery, amputations, gastric bypass surgery) reduction in mobility, functionality, and loss of independence. If there is long term recovery or post surgical complication depression may also occur more often.
Researchers have identified certain diagnoses and conditions where patients are at higher risk for experiencing depression, including the following:
- “A 13.7% incidence of depression on the first day of admission to the ICU.
- A 32% incidence of depression or PTSD of patients admitted to the unit after abdominal aortic surgery.
- The General Intensive Care Unit had clinically significant depression 28% of the time.”2
- “Depression is common in patients with diabetes and increases the rate of complications for this disease.”2
- Post-stroke depression “has an estimated prevalence as high as 80%.”2
- The Cleveland Clinic reports “up to 15% of patients with cardiovascular disease and up to 20% of patients who have undergone coronary artery bypass grafts (CABG) surgery experience major depression.”3
- Open heart surgery and heart attacks are also diagnoses closely associated with a much higher risk of depression.
- Men who are diagnosed with urinary, bowel, or sexual dysfunction are at a higher risk of experiencing depression.
There is some evidence that there are differences in rates of depression depending on age groups. Anesthesiologists did research which demonstrated that in terms of non-cardiac surgeries, anxiety and depression in elderly patients was less common.4
Most Common Signs & Symptoms of Depression
It is important to notice symptoms of depression like sadness, fatigue, and loneliness to get treatment.
Here are the most common symptoms associated with depression:
- Feelings of sadness or hopelessness
- Irritability
- Inability to sleep or sleeping too much
- Inability to experience joy or happiness
- Thoughts of death or self harm
- Loss of appetite or eating too much
- Inability to concentrate or focus
- Ongoing social isolation
- Loss of energy
Surgery can be a life altering event. Post surgery depression can be traced to a number of sources. It can be described as a situational depression. Patients can have a bad reaction to an anesthetic, ongoing pain, or a surgical outcome that did not meet their expectations. Surgery can cause people to feel disconnected to their bodies or view the surgery as an assault on their bodies. There can be overlap between depressive symptoms and depression that occurs post surgery.
Here are symptoms that are most commonly associated with post surgical depression:
- Anxiety or depression related to fears about quality of life or mortality
- Feelings of hopelessness and sadness related to ongoing pain from surgery
- Frustration or anger about loss of independence and body function related to surgery
- Irritability
- Loss of sleep because of discomfort or pain related to surgery
- Loss of self esteem in relation to changes in body or body image
- Anger/depression about long term lifestyle changes or reduction in life longevity relating to surgery or the underlying medical condition
- Loss of energy
- Changes in eating patterns like eating too much or too little
Risk Factors for Depression After Surgery
People who have a pre-existing diagnosis of depression are at higher risk for experiencing depression post surgery. The stress of surgical procedures can trigger a new onset of depression. Pain and discomfort and changes in routine can also be contributing factors to a diagnosis of depression. Fears about compromised life expectancy, thoughts about mortality, or long term health challenges can also promote depression.
A large research study was conducted with patients who underwent spinal surgeries. They noted that “12.3% of patients experience new onset depression, anxiety or both.”5 They went on to identify the risk factors which included “younger age, female sex, previous history of psychoses/neurological disorders, chronic opioid use and higher income.”5
Researchers reported that the combination of ongoing chronic pain in conjunction with opioid use heightened the risk level of depression for the patients in this study. Another important aspect to this research was their belief that people who earned more money might be more stressed about the possibility of their medical condition jeopardizing these earnings. They may also have higher expectations of a better outcome.
Psychologist Judith J. Wurtman, Ph.D, made observations about the unanticipated risks associated with general anesthesia used with surgical patients. She describes several potential changes in mood post anesthetic noting “attention has focused on anesthesia as more likely to be the risk factor for these mental disorders, including post-surgical psychosis, and more commonly depression.”6
Diagnosing Depression After Surgery
Mental Health and medical experts agree that depression after a surgical procedure can negatively impact the patient’s recovery and reduce the efficacy of the surgery. Attention must be paid to the physical, mental, and emotional recovery of the patient. The mental health of surgical patients sometimes is a secondary consideration. It is not always properly addressed with patients who need to undergo surgery.
Patients who are struggling with chronic pain, a serious life threatening diagnosis like cancer, or other serious illnesses that can impact quality or length of life, should be closely monitored for possible depression post surgery. If they display symptoms like hopelessness, anger, sadness, or an unwillingness to follow doctor recommended post operative recommendations, they should be evaluated quickly.
A mental health professional should be brought in to evaluate the patient determining if depression is a factor. This is especially true for patients who express ongoing pessimism regarding their future recovery, whose surgeries are deemed unsuccessful, or instances where unexpected medical complications worsen the patient’s condition.
There currently is limited research available regarding post operative depression and how it presents. This makes it more challenging for mental health practitioners to definitively diagnose depression in this population. Additional research needs to be done to get a better understanding in terms of identifying theories that have merit. This research is needed to offer more effective treatment practices to offset depression so it can be utilized in a timely manner. This will serve to benefit both patients and their families. It will also increase the possibility of a better post operative recovery from surgery.
How to Get Help for Depression After Surgery
The first step is to talk with your doctor. If your doctor does not bring it up ask about the incidence of depression in relation to the type of surgery you need. Talk to your doctor about other anticipated emotional reactions and mood changes related to your surgery. This will help you to be prepared in terms of your expectations. Knowing that depression is a possible outcome will help you feel less stressed or anxious about it happening. If you have a previous history of depression it is important to let your doctor know about it. You may want to revisit a mental health practitioner you previously worked with if the therapeutic relationship was a good one.
If you don’t know of any mental health professionals ask the doctor about recommendations. Working with a mental health professional can be very helpful. Try to find a mental health practitioner who has experience working with people who have chronic or acute medical problems that are similar to yours. Friends or family may be aware of potential referral sources. The hospital or clinic you are working with may also have staff that can offer counseling and support.
When to Seek Treatment for Post Surgery Depression
Facing a life threatening, newly diagnosed, or a chronic illness can be a harsh reminder about mortality. There is a sense of loss of control over your body and your life. Doctors are not always able to anticipate how a patient will react to surgery. The need for surgery necessitates trusting a doctor you may not have worked with before. This results in feelings of vulnerability and brings up issues of trust, fear, and anxiety. It is especially difficult to cope with when you have no prior health problems and suddenly you are confronted with the need for surgery.
Dr. Bernard Vacarro, MD, a psychiatry instructor cautions about the dangers of not getting treatment for postoperative depression. “Depression is a serious thing because it can impair the ability to cooperate with rehabilitation. Depressed patients have a significantly higher rate of complications.”1
If you are not willing or able to participate in your surgical rehabilitation it is important to seek counseling. Keep in mind depression after surgery may not be immediate. It often develops after patients have been home for a while and begin to recognize the challenges and limitations they must face and must try to overcome. If the symptoms previously described like hopelessness, loss of sleep, energy, or concentration, continue for 2 weeks or more, consider getting a mental health practitioner involved as quickly as possible.
The sooner you can begin working with a mental health specialist the better it will be. Because the longer you delay the more harmful it can be in terms of post surgical treatment and rehabilitation. The goal is for you to be fully engaged in rehabilitation to promote greater recovery and healing as quickly as possible.
How Post Surgery Depression Is Treated
Our physical health and well being are closely connected to our mental and emotional health. Seeking psychological support when needed can improve your medical prognosis.
There are multiple treatment options available to help manage post-surgery depression, including the following:
Therapy
Psychological treatment can help patients create a plan to identify and cope with depressive symptoms and surgical outcomes. In addition, having a trained professional to discuss and process feelings related to the medical diagnosis can be invaluable. They can also help to create realistic goals for your rehabilitation process. Finally, counseling can teach you skills to manage and reduce stress stemming from this healthcare crisis. Online therapy is widely available and easily accessible from the comfort of your own home. Importantly, online therapy is being shown to be on par with in-person therapy with regard to effectiveness.
Medication
Talk to your doctor to see if you are a candidate to take medications to help reduce stress and depression resulting from surgery. Your doctor will help determine what medications will not interfere with your post operative care.
Self Care
Reach out to trusted friends and family to discuss how you are feeling about your current medical status and possible fears about your future prognosis. There are also support groups and online chat rooms available where you can reach out to peers who have a similar diagnosis and relatable experience. They can share tips, insights, and information based on their personal experience that can be very meaningful to you.
What to Ask Your Doctor When Seeking Treatment
It is important to be honest and transparent with your doctor if you are depressed. Be prepared to describe your symptoms and how long you have been experiencing them. Share your medical history. It is important for your doctor to know you have had surgery, when it was done, and why it was necessary.
The reason for this is the treatment your doctor will offer will not impede your recovery from surgery. Bring information regarding what medications you are currently taking and the dosage. Your doctor needs all this information to be careful about not prescribing additional medication that might interact poorly with other medications.
When seeking treatment for depression, be prepared to ask your doctor the following questions:
- Based on what I have told you, what do you think my diagnosis is?
- Should I take antidepressants? If so which ones?
- How will they interact with my current medications?
- How long can I expect to be on this medication?
- Do you think I can benefit from getting therapy?
- Do I need therapy and medication to feel better?
- Does this medication have any side effects I should watch out for?
- How quickly can I expect to begin to feel better?
- Is there anything I need to avoid while using this medication?
- Will I be able to stop taking this medication when I am feeling better?
Tips for Coping With Post Surgery Depression
It is important to educate yourself as much as you can about your depression, medical diagnosis, and surgical recovery protocols. Having this knowledge will help you prepare yourself to create more realistic self recovery expectations both physically and emotionally. It will also help you feel more control in terms of your body and your feelings. Remember that all surgeries create some type of trauma, anxiety, or stress. Even when the surgery is elective. Understand that depression is not an unusual outcome for surgical patients and is not considered abnormal.
Here are some things you can do for yourself to accelerate your physical and emotional recovery:
- Make sure you follow your doctor’s orders regarding exercise and do what is recommended: Exercise helps your physical recovery from surgery. Physical activity reduces depression and releases chemicals in the brain called endorphins that elevate your mood.
- Get enough sleep: The National Alliance on Mental Illness advises “everyone experiencing depression should work to improve and regulate their sleep because there are only benefits to be had.”7
- Talk about your feelings: Find a close friend or family member you can discuss your depression, concerns, and fears with. This will offer some relief. Counseling can offer insights, coping skills, and a greater understanding of your strengths and areas you need support. If you need to find a therapist, a good resource is our directory.
- Be patient with yourself: Set realistic goals regarding your physical and emotional recovery. Consult your healthcare providers to help ensure your goals and time frames are appropriate. Achieving these goals will elevate your mood and your self esteem. Focus on your gains not your losses.
- Eat a healthy diet: This will help maintain your weight and give you necessary energy and nutrition to help you heal.
Tips for Caregivers
One of the most common mistakes caregivers make is not taking care of themselves. If you are taking care of a person post surgery it may entail helping them with mobility, self care, and taking on more responsibilities at home which can create physical strain on your body. Pay attention to pain and muscle aches in your body. You may need to ask for help from a friend, family member, or healthcare professional if the physical demands are too great.
Caregiving can also take an emotional toll. If you are caring for a loved one who has a dual diagnosis of depression and a medical condition it can create new and unanticipated challenges. Be aware of changes in your mood, increased stress, loss of sleep, anxiety, irritability, or your own depression. Get emotional support for yourself.
Talk to someone you trust about your feelings and fears. Here are additional tips to help you and the person you are caring for:
- Prepare your home: Be prepared so when the post surgical patient comes home it is set up to promote their maximum independence and safety. This will reduce the risk of future complications like falls. It will help their self esteem if they can do more for themselves and this will elevate their mood and yours.
- Be a good listener and observer: Be positive and point out medical and physical improvements you see post surgery and in terms of mood. Allow the person you are caring for to openly discuss their feelings. Listen without judgement. Be supportive and offer encouragement when needed. Celebrate each achievement and milestone.
- Communicate with healthcare providers: Caregivers who notice that a loved one continues to not adhere to healthcare provider recommendations should take action. Let the healthcare providers know this is happening so the appropriate interventions can be made. Left unchecked, non compliant patients can suffer physical and emotional setbacks that will lengthen recovery and diminish any potential progress.
- Reduce isolation: Surgery can isolate both patients and their caregivers. It is important to maintain social connections with family and friends that are positive and offer emotional and physical support for all concerned parties.
- Find creative ways for your loved one to spend time: If you can, find things you can do together. Examples include playing music, reading, games, watching a movie, doing crossword or jigsaw puzzles. Go outside if possible. All these activities can be great distractions and can make everyone feel better emotionally.
Additional Resources
There are resources available to offer ongoing support for post surgical patients who find themselves struggling with depression. These options are easily accessible online and are useful for those that may be confined to home post surgery:
- Anxiety and Depression Association of America: This organization offers education, resources and online community support
- Mental Health America: This organization does patient advocacy, education, public policy, and does peer support and support groups
- National Suicide Prevention Lifeline: Offers 24 hours a day/7 days a week counseling hotline at 800-273-8255, community support, education, advocacy, on line peer contact
- Substance Abuse and Mental Health Services Administration: Provides 24/7 hotline counseling services at 800-662-4357. Also offers treatment center locations, education, advocacy and advises on public policy
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
Are you ready to connect with a therapist but feel a little overwhelmed by all your options? Speak with one of Choosing Therapy’s Client Navigators. Client Navigators are mental health professionals who will listen to what you’re looking for in a therapist and help pair you with the best possible fit. Getting started is free, easy, and confidential.
