Depression After Bariatric Surgery

What Happens to Depression After Bariatric Surgery?

August 19, 2019

What is Depression?

Before we discuss the effects of depression after bariatric surgery, it is important to understand what depression really is. Many people confuse sadness for depression, but they are actually very different things. Everyone gets sad from time to time, and this is a perfectly normal part of being human.

However, the word “depression,” actually refers to a depressive disorder, which is something that can start when someone is experiencing sadness for a prolonged period of time in combination with other symptoms. Some examples of depressive symptoms can include one or a combination of the following:

  • Depressed mood (feeling sad, down, or blue)
  • Diminished interest or pleasure in activities
  • Significant weight gain or weight loss
  • Insomnia (trouble sleeping) or hypersomnia (sleeping too much)
  • Physically moving slowly or moving more than normal
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive inappropriate guilt
  • Difficulty concentrating
  • Recurrent thoughts of death or recurrent thoughts about suicide

There are many different types of depressive disorders. The most common of these is called Major Depressive Disorder or MDD.

MDD is a prevalent and debilitating disorder that consists of several depressive symptoms which can cause significant distress, impairment to functioning in some way (personal, interpersonal, or occupational), or both. It can occur as one episode, or it can happen multiple times. For example, 20% of individuals will experience a major depressive episode. However, individuals who have experienced a major depressive episode have a 50% chance of experiencing another one.

Depression and Bariatric Surgery Candidates

Countless studies have shown that obesity increases the risk of depression.

These studies have shown that about 19% of weight loss surgery candidates will experience depression compared to 8% of the general population. It is important to remember that there is some overlap between symptoms of depression and the physical consequences of obesity like fatigue, increased appetite, and poor sleep.

Other reasons why bariatric surgery candidates tend to have higher rates of depression can be related to overweight-related stigma, which can lead to social isolation and depressive symptoms.

Depression After Bariatric Surgery

Depression after bariatric surgery depends on several factors. First, it depends on how severe your depressive symptoms were before surgery. It also depends on if you are in treatment for your depressive symptoms or not. This is why it is important to reach out to a healthcare professional if your depressive symptoms persist or worsen before or after surgery.

Scientific researchers have been studying MDD and bariatric surgery for years. It is the most commonly studied psychiatric disorder in the bariatric population. An analysis that investigated several scientific studies conducted in 2016 found that depressive symptoms decreased following bariatric surgery in 11 of the 12 studies investigated.

Some of the reasons why depressive symptoms may improve after surgery include the fact that the individual who just had the surgery is starting to lose weight and is feeling a boost in self-esteem because of this accomplishment. Bariatric patients may also experience more energy after the surgery, even though they are consuming fewer calories.

As far as weight loss goes, there are mixed results from scientific studies. Some studies suggest that individuals who have a depressive disorder tend to lose less weight than their counterparts without depressive disorders, while other studies have found no difference between groups with and without depression. Still, studies show there might be a relationship between postoperative depression symptoms and poorer outcomes, so it might be a good idea to get treatment for depressive symptoms before it affects your surgery outcome.

Despite what studies seem to suggest, bariatric surgery should not be interpreted as a “quick fix” for depression.

In some individuals, depression may worsen after the surgery. This can be especially difficult with individuals who experience physical complications after the surgery, or for those who have difficulty losing weight. One study found that individuals who had depressive symptoms before surgery were at increased risk of major adverse medical events in the first month after surgery, so your depressive symptoms must be controlled before the surgery.

For individuals with severe depression, it is essential to know that there is an elevated risk of suicide for the bariatric population after surgery. The biggest predictor of post-surgery suicide is having past suicide attempts. Therefore, if you have a history of depression with a history of suicide attempt(s), it is important to stabilize your depressive symptoms before surgery and to continue to receive treatment after the surgery. Please do not ever feel ashamed for having suicidal thoughts. It is very frightening to experience suicidal thoughts, but you must view suicidal thoughts as a severe, life-threatening depressive symptom and talk to a healthcare professional immediately.

If you are ever suicidal and have a plan and/or intent to commit suicide, visit your nearest emergency room immediately or call 911.

For those experiencing depressive symptoms before or after surgery, help is available. Many are unsure where to start to get help for their depressive symptoms. You can talk to your primary care provider about options for treatment. Many primary care providers are adept at treating depression with medication.

Some other options include a referral to a psychiatrist (a medical doctor who prescribes psychiatric medication) or a therapist (a licensed professional like a psychologist, social worker, or marriage & family therapist who can treat mental disorders with psychotherapy). While it does depend on how severe your depression is, studies have shown that both medication and therapy are ideal for treating MDD.

Do You Have Depression?

How do you know if you have depression? You can visit http://cesd-r.com to take an online screening test for depressive disorders. If you are experiencing several of the symptoms listed at the beginning of this article, it may be time to speak to a healthcare professional.

Ideally, it is vital to stabilize your depressive symptoms before surgery. However, whether depression occurs for the first time in your life after surgery or it reoccurs after surgery, know that there are treatment options available with good scientific evidence to support them. While therapy and medication are usually the first line of treatment for depression, there are also other options for treatment-resistant depression (depression that doesn’t respond to therapy or medication).


References:

  • American Psychiatric Association. (2013). Major Depressive Disorder. In Diagnostic and statistical manual of mental disorders (5th ed.).
  • Dawes, A. J., Maggard-Gibbons, M., Maher, A. R., Booth, M. J., Miake-Lye, I., Beroes, J. M., & Shekelle, P. G. (2016). Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. Jama315(2), 150-163.
  • de Zwaan, M., Enderle, J., Wagner, S., Mühlhans, B., Ditzen, B., Gefeller, O., ... & Müller, A. (2011). Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. Journal of affective disorders133(1-2), 61-68.
  • Luppino, F. S., de Wit, L. M., Bouvy, P. F., Stijnen, T., Cuijpers, P., Penninx, B. W., & Zitman, F. G. (2010). Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of general psychiatry67(3), 220-229.
Joanna Benavidez

ABOUT THE AUTHOR

Dr. Joanna R. Benavidez is a licensed clinical psychologist. She has her Ph.D. in clinical psychology, and she is a certified clinical trauma professional (CCTP). Dr. Benavidez completed her internship and postdoctoral fellowship at Scripps Clinic Medical Group (SCMG) in San Diego, California. She is a member of the American Psychological Association (APA). Dr. Benavidez is the owner of a private practice in San Diego that focuses on providing presurgical psychological evaluations and works in cooperation with local hospitals to help individuals prepare for surgery.