Bariatric surgery and depression

[FrancescaS]

In May this year I had bariatric surgery as I was morbidly obese (sleeve gastrectomy), and since this time my depression has worsened and I'm currently in the midst of a major depressive episode. I'm wondering if there are any other BB forum participants who have similarly had bariatric surgery and also find themselves in a similar situation?

I’ve been doing a lot of reading about depression following sleeve gastrectomy surgery, in the hopes that I will discern why it has happened to me.

Most scientific/academic articles say that depression and other psychological conditions are more prevalent in bariatric surgery patients than they are in the general population. This is ascribed to the physical and psychological impact that obesity has on patients’ lives. The articles claim that bariatric surgery has a positive affect on patients’ lives given the health benefits of surgery and the boost to self-esteem that comes with being thinner. However, some studies have shown that a small number of bariatric patients have a psychological downturn following surgery, and one study has found that the likelihood of attempted suicide is 4-5 times higher in bariatric patients than it is in the general population. These articles make the case that this psychological downturn is the result of patients not being able to eat as much as they are used to, and/or patients turning to alcohol and substance abuse to manage their emotions following surgery, and/or patients having unrealistic expectations of the benefits of bariatric surgery. What seems to be absent though, to my mind, is analysis of the physical impact of bariatric surgery on brain chemistry.

Now, I am not a chemist, am not a scientist, so I cannot wait until further research is conducted into this issue. My pressing need is to dig myself out of the hole that I’m in. Or grab a ladder and start climbing.

Is there anyone else here in a similar situation?

FrancescaS

[Blue_Jane]

Hi Francesca

First of all thanks for taking the time to share what is going on with you.

It sounds like the surgery was a great step forward, even if you are not feeling the psychological benefits of it yet. To answer your question I have not been in your situation but I am wondering if your GP can recommend a therapist or psychologist, someone who might specialise in clients like you who have had this surgery? Or maybe your surgeon/specialist might know someone?

Your intelligence is clear from your post, sharing what you have found with a doctor will be interesting.

Hopefully someone else on these forums has some experience they can share.

Blue Jane

[White_Rose]

Dear Francesca

Hello and welcome to Beyond Blue. This is a huge topic with all sorts of issues hanging off it. Let me say up front I have no personal experience of bariatric surgery, but a friend had this surgery and lost a huge amount of weight. It's a topic I was interested in and I asked her how she was managing, was it easy? She battled through the change of lifestyle with the help of her adoring husband and I imagine her adult children.

I think you would have been to one or more psychology sessions before the surgery. Can you return to this psychologist for further discussion or perhaps a referral to another psychologist well versed in bariatric surgery and it's outcomes.

I love the way these so called expects make pronouncements on how people feel and decide that the impact of of a particular type of surgery. After surgery and probably for the next six months at least but more likely 12 months, there is a huge impact on the way you eat, what you eat and how you eat. This is where you need so much support and for the same reason you put on weight. There needs to be someone to help you eat only the amount of food your body will allow at any one time and provide reassurance, comfort and support.

I am certain anyone who had this surgery will feel so much better simply by being thinner and of course all the illnesses that hang off obesity become less likely. One reason I can think of for someone becoming depressed after surgery is the flat feeling once the surgery has been done. It's almost an anti-climax. You feel different but the weight is still there and will be for a while, though slowly going. I think we build up life changing events and get very disappointed when nothing much changes immediately. So maybe that's a reason.

What I know of depression, and remember most of what I know is from my personal experience, is that it hits without warning and often those people who are considered less likely to be impacted. It may be you have less resilience to counter depression, and remember you have had major surgery and recovery takes time.

It is interesting reading your comment about the increased likelihood of suicide in bariatric patients. The expectations from this surgery are high but require the patient to be very aware of the food they eat. I believe you can never tell another what this will feel like. The other thought I have is about the realisation that this surgery is irreversible so no matter what the patient wishes they are stuck with it.

Mary

[FrancescaS]

Dear BlueJane

Thank you so much for responding so kindly to my post. Yesterday I had my first session with a psychologist who actually specialises in brain chemistry and nutrition (what a God-send!). She has diagnosed "burn out" (I work in a senior role full-time and am also undertaking a PhD). While I was with her she rang a chemist to discuss what I'm eating and my nutritional needs. In addition to pregnancy Elevit I am now taking Bioceuticals Mega B & Q10 as well was Ostelin Vitamin D. She strongly recommends that I have leave from work until September. I have now applied for a 6-month intermission for the PhD. She reassured me that she has seen many bariatric surgery patients and they too have been suffering from depression. She says she is confident that I will recover and regain my health. I feel like a lifeline has been thrown to me - I still feel shaky, but now have hope.

[FrancescaS]

Dear Mary,

Thank you for your thoughtful comments. The surgeon that I went through does not include any psychological assessment prior to or after surgery - nothing. His focus is purely on weight loss. I naively thought that as my obesity was causing me physical and mental distress, bariatric surgery would take this away - I was very wrong! It turns out that there is a strong connection between the gut and mental health.

My advice for anyone contemplating bariatric surgery with an existing mental health condition is to work through a psychiatrist or psychologist with a strong interest in brain chemistry and nutrition before scheduling surgery.

I am lucky to be writing this on the 9th August 2017. Exactly one week ago I was planning my suicide. I was 12 weeks post surgery. I have had some trauma in my life, but I have never felt as bad as I have since bariatric surgery.

FrancescaS

[White_Rose]

Dear Francesca

I am so pleased you are still here to talk to us. Suicide is a topic that usually has everyone in the room trying to think of something else to talk about. It would be funny if it were not so serious and damning.

I am surprised your surgeon did not send you to a psychologist for at least one session. It's not as though the surgeon went through this stuff. While it's true, I'm guessing, that some patients may have a change of heart after meeting with a psychologist, surely the surgeon must have some consideration of the psychological effects. Doesn't part of the Hippocratic Oath say, And do no harm. I am really surprised. My GP sent me to a surgeon to discuss gastric banding. In turn he sent me to a psychologist and another doctor.

It was the doctor who put me off. She pooh-poohed my fears about eating after surgery, told me I would breeze through it because her husband had been OK after his surgery, made no attempt to discuss my weight and if there was an alternative. I didn't go back. Mind you I was not entirely convinced in the first place.

It's sad that you came so close to ending your life and I am thankful you are here. I have gone down that road and I know how hard it was for me to come back. Suicidal thoughts are a measure of your distress and that of anyone else in that position. The thoughts you had about yourself before the surgery will not simply disappear. While you may understand what has happened to your body and what steps you need to take after surgery, it's all tucked up in your brain. Your body has not had a chance to process it.

I have been fortunate to have a very skilled GP who is quite fussy who she refers me to. My doctor often reminds me about the time lag between learning something new and understanding that new information, and the time it takes to filter through the rest of the body. Your body remembers itself and in your case it remembers how you used to eat, what you ate etc. It takes time for your stomach and the connections to the brain to accept this.

I often call it head and heart understanding. Your head understands that you had surgery and why. You processed all this information before having surgery. Your body didn't realise how much it would affect you physically or realise how hard it would be to reduce your food portions until it started to happen. Big shock. Now you are having the old thoughts about eating and depression and your brain is saying you cannot eat much. Out of words.

Mary

[Blue_Jane]

Hi Francesca

Gosh that psychologist sounds great. What an interesting specialisation. Are you going to see her again? I know it is expensive but sounds like a positive investment.

Burn out makes sense with everything going on! I guess it is too early to feel any difference as a result of the supplements and diet? Because of my mental illness I am mindful of my diet and supplements too, I eat a lot of strawberries and blueberries as they are apparently great for our minds.

I am sorry to read that you were contemplating suicide. Thank goodness you are still here with us making constructive steps forward.

How do you feel about going back to work next month?

Blue Jane

[dare2diva]

Hi. I had sleeve 11 weeks ago and I have had a rough recovery. 3 additions for dehydration due to vomiting and not being able to eat or drink. I have schizoaffective disorder and anxiety has now come forward every time I go to eat because I’m terrified I will be sick. I can eat half a cracker and half a teaspoon of tuna a day. Anymore and I’m sick and other foods i loved like dairy tea coffee fruit chicken veggies I just can tolerate. Surgeon and dietician have said it will get better and to keep trying but I want a damn date. It’s been 11 weeks of feeling like hell. Not having energy constant head and muscle aches and nausea from hell. I can’t walk into the kitchen because I get so anxious and I can’t watch people eating or cooking even on tv. Now I’m wondering if I’ve got anxiety which is causing me to vomit. Psychiatrist and psychologist don’t seem concerned. Nobody seems concerned but I have no energy. I have trouble showering everyday because I am so exhausted. I have to work from home but they are getting annoyed with me asking when I’ll be back. I’ve tried to go back 3 times twice I fainted and once my body just collapsed. Where do I turn for help? I am so incredibly hungry it is causing severe stomach pain. Of course I can’t keep my regular medication down every day because they are big uncoated and hard to swallow. I am so incredibly angry I feel anger beating in my head all the way down to my toes. My heart is pounding. It’s all doing my head in and I don’t know what to do. I’m hoping somebody has had a similar situation and come out the other side.

[White_Rose]

Hello dare2diva

Sounds like you are having a horrible time and I am sorry this has happened.

On a practical level can you ask your GP to prescribe different medication that is coated and smaller. I know that usually there are several brands making the same meds and one of them may be more comfortable to swallow. There may even be a pill you can chew before swallowing.

I can understand how frustrating it is when no one appears interested in in how you feel. I think it is more likely they do not understand your feelings and reactions and find it hard to relate, though a psychiatrist and psychologist should understand how to relate to you.

I had a similar operation at the end of July, a gastric by-pass. I am also struggling with eating. I have a severe reflux of bile from my stomach which makes everything I eat taste disgusting. I too can only tolerate a few foods. My surgeon gave me medication to line the stomach and stop the reflux. It does work so long as I remember to take it before eating. Sorry I cannot give you the name as this is against forum rules. Previously the reflux gave me very bad chest pains and I have ended up in hospital a couple of times because of the pain. They are always concerned with chest pain and want to make sure all is well there.

It sounds like your vomiting is due to anxiety although I have done this a couple of times due to eating the wrong food, eating too quickly or too much. I am working on this. My weight has been dramatically reduced and I try to remind myself of this when I struggle. It is getting better but it's a slow process. Do you live alone? I think it is a hindrance as there is no one support to you when you get anxious.

I love fish but found it one of the foods I cannot eat. Fried or oily food is also a no-no. I have gone back on the diet drink I had to start with before the surgery on occasions. Cannot drink a full amount but my dietician said to use less water to make it and make it a thick-shake. No need to worry so much about nutrition and it will help line the oesophagus which may well be still inflamed from the surgery. In any event it is easier to swallow. Try it for one meal a day or try the various other diet foods made by this company.

Once your body can start accepting this food you may be able to start eating 'real' food. Have a chat to your dietician about this option. It may be OK for a couple of weeks and help with the anxiety.

Hope this has been helpful. Feel free to write in again.

Mary

[future_]

you have to push thru your thoughts my friend. each day take another extra spoonful of tuna. I am the opposite I emotionally eat and have to really concentrate on not picking up anything available. Please try and eat a couple of grapes and two crackers and just a fraction more each day, you have to go to work so you can pay the bills. keep going someone needs you today xox