"Stable mood" questions

One of the criteria for being eligible for surgery is to have a stable mood for a minimum of one year.  I have been on antidepressants for the last decade to help with the hormonal nightmare and depression caused by PCOS.  Does that mean I can never have surgery?  I am confused - anyone else know anything about this?

I think this is an incredible question.
I am really taken back by the lack of focus on how psychology impacts the eating disorder of overheating.
I am not a pdoc or a phd, just a mere masters in psychology, but I feel that at least 75% of the people that need/get this surgery have experienced unstable mood. For most, it is the unstable mood that causes our obesity. To demand stable mood for 12 months prior to surgery is, IMHO **** joke and probably disqualifies the a good majority of people that go for surgery.
I think everything is based on a continuum of symptoms in relation to your psychological baseline. You will always have your ups and downs. They key for any proper psych assessment is what plan you have in place to manage those ups and down. If you have no plan with severe mood fluctuations, I can see you being delayed. I was delayed for 6 months because of perceived severe mood instability (even though it was not due to organic illness, rather immediate situational). Dim wit psychiatric intern didn't know how to ask questions and drew the wrong conclusions. Alas, after waiting 6 months and having an 'interesting' conversation with the staff psych, I was cleared for surgery.
I am really quite fascinated by this element of the evaluation process. Please feel free to contact me again if you have questions or concerns.

I didn't read your response before I wrote mine but you wrote it much more succinctly than I did - I agree with you. The plan for how you will deal with eating and emotional issues and whether you can put that plan in to place now with success is just as, or more, important than if your mood is by the books stable. 

I think, from my experience anyway, what they are looking for is that while you may have small ups and downs in the last 12 months, for the most part your moods are stable. They want to know if you feel your medication and/or therapy is working. I have been on meds for 10+ years, but off for the last two and just doing CBT work. My family doctor doesn't agree with me being off meds but the psychologist approved me anyway because I've demonstrated that while I still have issues with mood swings and depression related to PMS (possibly PMDD?) I am still functioning and taking the initiative to prepare myself for surgery. What functioning means is relative. For me it's that I can get up every day and go to work, I can take care of my home and my self, I have healthy relationships and a good support system. For someone else functioning may mean that they can make it to the grocery store on their own, they can keep their house clean without assistance, they have a good mental health team or the full support of their family doctor behind them. Maybe they can't work or maybe they are living in supportive housing, but they are still functioning independently and for the most part their moods are predictable. I don't know what the percentage of WLS patients are with some form of depression, either clinical or chronic low-grade, or s.a.d, but I'm willing to bet it's a large number. So they can't expect that we are all having the best time of our lives right before surgery. They need us to be stable because it's an enormous change - emotionally, psychologically, hormonally, physiologically - and if they think there's a chance you may have a severe downturn in mood they will want to address that. And it's only for your own success. The social worker I saw thought I had a pattern of s.a.d and proposed postponing my surgery until the late spring when there was a likely chance I'd be out of the depression red zone (my own psychiatrist changed her opinion on that) She wasn't doing it to make me wait longer because I have had mental health issues in the past, she had my best interests at heart.

I think mental health is such a personal thing and what stable is for one person might look slightly different for the other. Issues with mental health in the past isn't necessarily a barrier to surgery, they just need to be sure that you are going to be successful.  

Hi Zizzler,

I agree 110% with everything Katie M had to say.  I had been depressed from 1989 to 2010, and at times extremely depressed, as low as you could possibly get.  However, I have been feeling pretty good since then, and my psychiatrists were my advocates for surgery.  Your use of antidepressants does not rule you out as I have read that more people than not who have WLS have some form of mental illness, and almost always that is depression.  But, be forewarned that the bariatric team's psychologist and psychiatrist (if you even meet him/her - I didn't have to) will call your current psychiatrist and talk to them at some length, so tell your psychiatrist that they need to advocate for you and that the golden words are "mentally stable".  I do not work and I was still cleared for surgery.  Because my former psychiatrist had retired a month or two prior to me going to my current psychiatrist, both were called.  Also, the psychiatrist who prescribes my meds (and I take quite a few more than you do) was called, but he never called the psychologist back, so they based their decision of my interview and my 2 psychiatrist's opinions.

I am 110% sure that you will have surgery, and will be cleared for surgery by the bariatric team's psychologist or the psychiatrist.  Be patient, you may not be as lucky as I was and you may have to attend more than one meeting with one or both of them, but it will happen.  I was very worried about 'passing' this requirement.  I found Dr. Wynuk of TWH to be a very nice, friendly, compassionate, 'normal' woman (she's a psychologist), compared to the social worker whom I saw first and whom did not even smile at me once and was obsessed for some time at how I would be able to afford $50.00 worth of vitamins/month, but she eventually gave up on that rather ridiculous argument since I was well taken care of and not exactly living in a cardboard box, but am supported by my parents.  So, even if you are so impaired that you do not work, you are not going to be automatically disqualified.

I hope my answer has put your mind at ease.  I know I wasn't much reassured until I met the surgeon and was told the operation was a go though.  But then, I have a tendency to worry.  They really do have your best interests at heart when they make sure that you've been mentally stable though.  You definitely need to be able to follow the rules post-op and make the most of your golden time after surgery to lose weight.

Good luck!

Jenn.  :)

Jenn - I'm glad you had such a positive experience with the pdoc(s) at TWH. I am glad you had faith in them and their ability to assess you. Sadly, not all of us felt such a level of confidence.
Even though I am all about siding with caution and delaying things until the time is right (rather than rush something to the end of failure), I am growing increasingly skeptical of the 'watchful eye' of those practicing in the mental health profession - and I speak from my own experience at TWH and their psych faculty.
The intern that interviewed me asked me surface questions and to my surprise made incorrect deductions - causing me a 6 month delay. Upon meeting the staff psych his patronizing ego was nauseating and it was only by gods grace that I knew a bit of something and held my own in the conversation. If I was someone more vulnerable, that meeting could have really shook me up and do me in.
In as much as i blindly put my faith in the surgical team, I definitely do not in the psych team.
I think someone said to make sure your pdoc is on your side yadayadayada. I agree with this. Ideally you have discussed this at great length with your therapist/pdoc and they support you. Hopefully they will advocate for you in case you are incorrectly assessed, as I was. My pdoc was semi retired and spent his time on holiday or lecturing in the states. Miscommunication took place and it all contributed to the 6 mth delay. I'm not even that 'complicated' - not psychotic, disassociative, etc.. Depression is my thing.
For some, getting the surgery sooner is better for mental health than having to wait 6 months. From my experience, I feel the assessment system in this area needs bettering.

As well - I find it interesting that you didn't have to have assessment but they just took the word of your pdoc. This is interesting - especially considering your long standing history. You were assessed at TWH?
It shouldn't be that way. At all.

Hi there,

I was assessed by the psychologist, Dr. Wynuk.  She certainly spent a full hour with me, going over my past any looking for any problem areas that might have impinged on the success of my surgery.  Her assessment was correct, I am not depressed now either, and remain mentally stable.  Luckily, that was as far as the assessment went in my case.  Don't forget I had not just been feeling 'mentally stable' for almost 3 years, but not depressed clinically.  Not everyone requires an assessment by a psychiatrist at TWH.  That's solely based on what the psychologist ultimately thinks, following your interview with him/her.

Why shouldn't it be that way?  We are both in favour of easier, faster surgical clearance for people with mental illness.  She spoke to my new psychiatrist and my retired psychiatrist who had been seeing my for 8 years at length and several times.  Also, believe me, I had no faith in the ability of the TWH team to assess me the way my own psychiatrists could assess me.  I'm sorry that you did not see her, but evidently saw another psychologist who sent you to see some newbie psychiatry resident (it could not have been an intern), who got his facts mixed up.  Dr. Wynuk easily separated exogenous factors causing mild, transient depression, e.g., my Grandpa dying and my Mother's brain tumor, from non-existing current endogenous depression.

Jenn.  :)

P.S.  I was the one who said that your own psychiatrist(s) must become your advocates for the surgery.

I think what I am suggesting is that all intake should be standardized. I appreciate the need for faster clearance, but assessment should be standardized.
I got no preliminary psychologist - I went straight to the pdoc newbie. Why was there this discrepancy?
I'm not being a ***** by saying that you should have had a full pdoc screening like others have at TWH, I am just asking for a more standardized approach - either way. Maybe they should skip doing full psych assessments for those with history and simply speak directly to the clients pdoc (so as to get good quality info) - like I guess they did with you. Im thinking of those moving forward - like the person who started this post. to better streamline, as you are suggesting here.
Or , perhaps anyone with MI history should get a full psychiatric screening at TWH. Whatever. Just make it standardized.
It's just so interesting that some of us have gotten very different experiences in this area out of the same hospital. Lol.

I guess it just depends on the psychologist you speak to at TWH whether they handle everything or not.

Speaking of standardization, why on earth are the rules for pre-ops so different at some centres too?  What you can eat on Opti, what physical tests are mandatory, etc..

Jenn.  :)