Why You May Be Depressed After Surgery and How to Cope

Surgery is typically performed to improve or manage a health condition and help a person feel better. But from a mental health perspective, operative procedures sometimes cause people to feel worse.

Depression is a common complication of surgery, which can lead to further side effects and complications including infections and cognitive impairment, according to a February 2016 review in ‌BMC Surgery‌. "Studies suggest that up to 25 percent of patients having surgery experience some degree of postoperative depression which can last up to six months," says Tracey Childs, MD, chief of surgery at Providence Saint John's Health Center in Santa Monica, California.

The reasons why are complicated, and some people may be at higher risk than others. Here's a look at how depression can take hold after surgery, common symptoms and what you can do to feel better.

Life can look pretty different immediately following a surgical procedure, and it can take a toll emotionally. There's a few factors that can play a role in depression following surgery:

"Most of the normal daily activities that contribute to a sense of wellbeing are disrupted," says G. Thomas Shires III, MD, a general surgeon at Texas Health Presbyterian Hospital Dallas and Texas Health Physicians Group. You might be confined to bed, unable to engage in your normal routine or do activities without a lot of help. You may have to eat different foods or spend lots of time caring for wounds or doing exercises to help you heal.

It's easy for your mood to sink when you're physically uncomfortable, and medications used to manage pain can affect mood. The problem can be compounded if your pain is making it hard to sleep. And if you're anxious over your recovery or how the surgery will affect your health condition, that can play in too, Dr. Childs says.

"Emotional stress related to the diagnosis or treatment can increase the risk of postoperative depression."

Anesthesia used in surgery could play a role too, according to July 2017 research in ‌Expert Opinion on Drug Safety.‌ "General anesthesia can frequently produce delirium or cognitive dysfunction," Dr. Shires explains. "The patient's perception of these altered states can contribute to acute situational depression."

Depression, whether caused by surgery or something else, often manifests with similar symptoms, Dr. Childs explains. Per the National Institute of Mental Health (NIMH), these may include:

• Persistently feeling sad, anxious or empty
  
• Feeling hopeless or pessimistic, particularly about your diagnosis or recovery
  
• Irritability
  
• Loss of interest in the things you normally enjoy
  
• Lack of energy
  
• Trouble concentrating, remembering or making decisions
  
• Trouble sleeping
  
• Changes in appetite or weight
  
• Unusual aches or pains
  

Some of the symptoms that are a normal part of surgery recovery can overlap with depression. "Fatigue, irritability, altered appetite and sleep disruption are all common to the early postoperative period as well as depression," Dr. Shires says. But if you continue experiencing these symptoms for more than two weeks after surgery, depression could be the culprit.

It's worth pointing out too that depression can take different forms for different people. "It looks different for everyone and can look different for each person at different points in their life," says Morgan Levy, PhD, a psychologist in Boca Raton, Florida. For some, "postoperative depression could show up as an increased sense of vulnerability because the body is in a vulnerable state," she explains.

Depression is typically treated with behavioral therapy, medication or a combination of the two, according to the NIMH. That's also the case for depression that develops after surgery, according to the ‌Expert Opinion on Drug Safety‌ study.

"My best advice is to reach out to a medical professional and mental health expert for treatment," says Levy, who notes that talking with an expert specializing in healthy psychology could be especially helpful.

Taking preventive measures before surgery can make a difference too. For starters, be aware of your risk factors and discuss them with your surgeon, Levy advises.

If you already have symptoms of depression or anxiety, surgery could make them worse. You may also be at higher risk if you have a family history of depression or lack a strong support system to help you with your recovery. In some cases, you may be able to start working with a therapist before surgery or put a preventive plan in place to start talking with someone shortly after surgery, as soon as you're up to it.

Setting the stage for success pre-surgery also helps.

"A strong support system can alleviate the isolation of recovery and anxiety about life requirements that are temporarily out of the patient's control," Dr. Shires says.

You could plan to have someone be available to sit and keep you company for an hour every afternoon or arrange for someone to bring groceries once a week, for instance.

Ask your surgeon when you might start feeling more like yourself and be able to regain some of your independence. And go into surgery knowing that your mood might take a dip.

"Feelings of sadness, fear or loss are normal after surgery," Dr. Childs says. "Giving [patients] information and tools prior to their operation eases the way of their recovery and minimizes the impact of any depression they may experience."