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.
What Is Post Surgery Depression?
Depression is a complication that can occur for people who just had surgery. Despite all efforts to combat the blues of being limited temporarily and even with a strong support system, developing post surgery depression is still very common. Those who have a baseline of depression are likely to have exacerbated depression symptoms following surgery, however it can happen to anyone. Some of the causes are specific to the individual’s mental health history; however, some causes can be related to medication and physical complications.
Is Depression a Side Effect of Surgery?
Depression is considered a side effect of surgery the same way pain and soreness is, however it’s not talked about as much. Due to the physical limitations someone may have after surgery, it can trigger a feeling of despair. To add, then needing to rely on others for help after surgery can leave people feeling like a burden, further adding to the emotional load which can lead to depression. Surgery itself is very stressful on the body and it takes time to recover, and even when someone has recovered physically, it doesn’t mean their emotions have caught up. They may also be experiencing anxiety or fear related to the circumstances which led to the surgery, and it’s important to discuss this with your medical team.
Is It Normal to Be Tearful After Surgery?
It is typical to experience tearfulness after surgery. Surgery is taxing both physically and emotionally, and sometimes surgery is a relief to pain or suffering. Even if the battle after surgery is uphill, knowing that a surgery did occur with the goal of addressing a problem can lead to a lot of different emotions which can manifest as being tearful.
Can Your Personality Change After Surgery?
Depending on someone’s circumstances for surgery and what kind of surgery they had, temporary changes to personality can occur. This can be related to changes in mood such as dealing with depression, or it can be related to a new outlook that some people experience after surgery. Others also experience ongoing confusion that can be linked to postoperative cognitive dysfunction. If you are feeling any kind of confusion or disorientation after surgery, speak with your medical team.
Common Signs & Symptoms of Post Surgery Depression
Common signs of depression after surgery include irritability, hopelessness, and changes in sleeping. It’s important to recognize the symptoms of depression in order to get the proper care.
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 or sadness 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
What Causes Depression After Surgery?
Surgery can be a life altering event. Post surgery depression can be traced to a number of sources. It can be described as reactive depression. Patients can have a bad reaction to an anesthetic, ongoing pain, or a surgical outcome that did not meet their expectations. Fears about compromised life expectancy, thoughts about mortality, or long term health challenges can also lead to depression.
Causes of depression could include:
Pre-Surgery Depression
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.
Chronic Pain After Surgery
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.5
Other Risk Factors for Post Op Depression
Risk factors for developing depression after surgery include:5
- Younger age
- Being female
- Previous history of neurological disorder
- Chronic opioid use
- Higher income (those who earned more money might be more stressed about the possibility of their medical condition jeopardizing these earnings)
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
Surgeries With a Higher Risk of Depression
Researchers have identified certain diagnoses and conditions where patients are at higher risk for experiencing depression, including the following:
- 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
- A 13.7% incidence of depression on the first day of admission to the ICU2
- A 32% incidence of depression or PTSD of patients admitted to the unit after abdominal aortic surgery2
- The General Intensive Care Unit had clinically significant depression 28% of the time2
- Depression is common in patients with diabetes and increases the rate of complications for this disease2
- Post-stroke depression has an estimated prevalence as high as 80%2
- Men who are diagnosed with urinary, bowel, or sexual dysfunction after surgery are at a higher risk of experiencing depression2
10 Tips for Coping With Post Surgery Depression
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:
1. Be Prepared & Understand What to Expect
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.
2. Follow Your Doctor’s Orders Regarding Exercise
Exercise helps your physical recovery from surgery. Physical activity reduces depression and releases chemicals in the brain called endorphins that elevate your mood.
3. Get Enough Sleep
It’s commonly advised that anyone experiencing depression should work to regulate their sleep schedule and get more sleep. Sleep is incredibly important for healing, and sticking to a set schedule can be helpful as well.6
4. Eat a Healthy Diet
This will help maintain your weight and give you necessary energy and nutrition to help you heal.
5. 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. In addition, 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 an online therapist directory.
6. 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.
7. Get Out of Bed Each Day
It’s important that you take small strides daily to achieve your treatment plan post surgery. Getting up each day on time and having a routine will help bring a sense of normalcy in an otherwise unusual situation.
8. Go Outside When You Can
Getting outside each day is just as important to include in your daily routine. There are a lot of benefits to being outside in nature or even just in fresh air. Depending on your limitations post surgery, and ensuring it’s safe to go outside, making time to spend 20 minutes each day outside can be very healing.
9. Focus on the Positive
While there are going to be a lot of small steps to take and barriers to cross, focusing on how far you have come while honoring your whole experience is a good way to frame your recovery. It takes into consideration a mindful approach and living each day with gratitude and intention.
10. Set Healthy Goals
Think about setting realistic and smart goals for yourself. Our goals are often long-term goals, but oftentimes after surgery, you have to plan for more short term goals and tasks as milestones to reach the long-term goal. Thinking about how to break down your long-term goal into small goals that you can work toward each day is the best way to manage your own expectations of recovery.
When to Seek Treatment for Post Surgery Depression
If symptoms 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. 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.
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 physical and mental healing after a surgery.
Therapy
Therapists can help patients create a plan to identify and cope with depressive symptoms and surgical outcomes. They can also help to create realistic goals for your rehabilitation process. 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, so it’s a great option for those still in recovery after surgery.
Medication
Talk to your doctor to see if you are a candidate for antidepressant 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.
Support Groups
Support groups and online chat rooms can be helpful resources, as 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.
How to Get Help for Depression After Surgery
The first step is to talk with your doctor. If your doctor does not bring up post operative depression, 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. Additionally, you could use an online therapist directory where you can filter by location, expertise, and insurance.
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.
If they aren’t aware already, it is important for your doctor to know you have had surgery, when it was done, and why it was necessary. 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 after surgery, 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?
How to Help a Loved One With Depression After Surgery
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 to avoid caregiver burnout.
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 judgment. 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.
For Further Reading
- 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
Depression After Surgery Infographics
