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How to Deal with Depression after Major Surgery

written by: Dr. Jerry Kennard • edited by: Paul Arnold • updated: 6/6/2012

A little known but very common consequence of major surgery is depression. Although depression is a debilitating disease it does respond well to treatment. Speedy intervention and a little self-help can speed recovery and help to prevent a relapse.

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    We have become accustomed to the technology that supports both medicine and surgery. Technology is important of course but it often overshadows the emotional distress of the patient during the lead up to surgery and the post-surgery recovery phase. The most common emotional consequence of major surgery is depression. Depression is a serious illness and occurs after major surgery more often than may be realized. Following heart surgery, for example, as many as 1 in 3 people are thought to experience major clinical depression.

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    What Causes Depression Following Major Surgery?

    Depression may result because of the anesthesia used, or as a side effect of medication, or the pain and discomfort the sometimes occurs during rehabilitation. It is also more common in people with a history of depression.

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    Signs & Symptoms of Depression

    The symptoms of depression following major surgery may appear almost immediately or months later. Many people don’t realize they are depressed because they believe depression relates to sadness and tearfulness. It’s true that these are symptoms of depression but far more common symptoms are listlessness, irritability and a feeling of flatness. Sleep disturbances, loss of appetite and a general lack of energy are common following surgery, so some overlap does occur with the clinical symptoms of depression.

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    Treatment Options

    Depression following major surgery may be commonplace so it’s good to know that around 80-90 per cent of those affected respond positively to treatment. Treatment options include:

    Medication

    Anti-depressant medications are likely to be one of the first things to be prescribed for your depression. Research suggests that antidepressants, in combination with psychotherapy, are often the most effective mix. The most widely used antidepressant medications are the selective serotonin reuptake inhibitors (SSRIs). These tend to be safe to use in combination with other medications but your doctor will advise you of any special circumstances or limitations.

    Exercise

    An increasing body of evidence points to exercise as an effective treatment for mild to moderate depression. One of the positive effects of regular exercise is that it can counter the effects of weight gain that often comes about as a side effect of antidepressant medication. Around 150 minutes of brisk walking a week is sufficient to promote a sense of wellbeing, and improve circulation and overall physical fitness.

    Cognitive Behavioral Therapy (CBT)

    CBT is a form of psychological therapy. It has a good research track record and is highly effective in the treatment of depression. Many people find it more effective than antidepressants. A 12-week, randomized, single-blind clinical trial with outcome evaluations conducted at the Outpatient research clinic at Washington University School of Medicine, St Louis, Missouri, found CBT and supportive stress management performed well for treating depression after coronary artery bypass surgery. Of the two therapies tested researchers found CBT to have the most durable effects.

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    Self Help for Depression

    Self Help for Depression

    There’s a lot you can do to help yourself cope with depression and to speed recovery. For example:

    • Stay away from alcohol, fatty foods and foods with a high sugar content.

    • Stop smoking.

    • Get some fresh air every day.

    • Get a good sleep at night.

    • Follow your prescribed medication or psychological therapy guidelines.

    • Practice relaxation techniques.

    • Avoid stressful situations.

    • Stay in contact with friends and relatives.

    • Get involved in exercise, resume hobbies or start new hobbies.

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    References

    "Depression and Other Medical Conditions." University of Michigan Depression Center. N.p., 20 01 2006. Web. 23 Sep 2010. <http://www.med.umich.edu/depression/condition.htm>.

    Freedland KE, Skala JA, Carney RM, Rubin EH, Lustman PJ, Dávila-Román VG, Steinmeyer BC, Hogue CW Jr. Treatment of depression after coronary artery bypass surgery: a randomized controlled trial. Arch Gen Psychiatry. 2009 Apr;66(4):387-96.