NEW Depression During WLS

Living With Depression After Weight Loss Surgery

March 18, 2020

Living With Depression

Living with depression after weight loss surgery (WLS) can be challenging, especially when you are trying to change your habits after surgery. Depression after weight loss surgery can make it harder to change your relationship with food. Symptoms of depression, such as fatigue and loss of energy, will also challenge your need to increase your activity level post-surgery. Further, some psychotropic medications can be a contributing factor to obesity and may need to be changed.

There is some evidence that bariatric patients are at higher risk for suicide (Omalu BI, Ives DG, Buhari AM, et al., 2007). The diagnosis of depression does not disqualify one from approval for surgery. If a person is managing depression symptoms well, they are a good candidate. WLS is not a cure for depression, but there is evidence some patients experienced a significant reduction in symptoms post-surgery (Burgmer R, Petersen I, Burgmer M, de Zwaan M, Wolf A, Herpertz S., 2007).

Most patients desiring weight loss surgery have a healthy attitude and are highly motivated to change behaviors that lead to weight loss. However, the problem arises with patients that may have unrealistic expectations or do not adequately prepare for the changes ahead. Not preparing for these changes can be overwhelming, causing a feeling of failure.

Change is not easy. By developing a plan you begin to accept a new life and prepare successfully for the journey.

Depression After WLS

Strategies for Successfully Managing Depression After Weight Loss Surgery

Mood fluctuations post-surgery are common and should be expected. Change can be uncomfortable, and the unknown is often frightening. It is not unusual to have doubt, be irritable, or feel alone after surgery. This is especially true if you previously struggled with depression, experienced surgical complications, or are in the midst of a life stressor.

It is important to start a coping strategy savings account. Have it ready, so when you see the possibility of depression creeping in, you can access it. Practice these new strategies in advance to see which work best for you.

Begin with a self-analysis: Take the time to get to know yourself and your relationship with food. Is food your strategy for working through periods of depression or stress? When do you make unhealthy food choices or tend to overeat? Look at the meaning food had in your childhood, teenage years, and adult life.

If food is a comfort, a friend, or a means of control, you can start by acknowledging it then develop a new definition of food. Food is for sustenance. Make a list of all of your old definitions of food and another list with new definitions. Replace emotional eating by trying a new hobby, develop friendships with other bariatric patients, do a craft, walk, or listen to music. Practice the new coping well before you have surgery.

It could be helpful to start a journal. An outlet for your inner struggles, such as writing can be cathartic. Consider jotting down weight, physical symptoms, and simply logging your mood. Journaling does not have to be complex or lengthy. Writing a single word as an entry can be helpful. This can give you insight into mood fluctuations that may occur. You may discover a relationship between activities and mood changes. Some patients have been able to detect complications such as vitamin deficiencies (which can trigger depression symptoms) because they noticed a change.

A journal is a good reminder of where you have been and help you unravel goals you wish to attain.

Make a transition from food as a primary social outlet to being more active. Unfortunately, for many of us, food is the center of most activities. Food may be a center point at family gatherings, celebrations, or even the loss of a loved one. Identify traditions and habits that need to be changed.

Try positive self-talk. There's a strong relationship between your thoughts, emotions, and behaviors. What we are telling ourselves is often automatic since we have been doing it for years. Evaluate what thoughts pop into your mind that lead you to overeat, make unhealthy food choices, or decrease momentum. Common thoughts include, "I'm not good enough,  I am alone, food is my friend, or I will never attain my goal." Learn to replace the negative thoughts with healthier ones such as "I am enough, or I am not alone."

Prepare your loved ones. Depression can make it more challenging to cope with changes in relationships that emerge post-surgery. Talk to your loved ones about your goals, fears, and potential challenges. Your decision to have surgery could affect how you interact with others.

For example, some relationships are based on socializing around food (such as family gatherings, date night, or church functions). Begin by discussing how the relationship will not change, but interactions while socializing will change. This gives your loved ones the opportunity to participate in your journey and be more accepting of the change. In addition, it sets the tone for understanding your new relationship with food rather than take it personally.

The timing of the surgery is essential. Consider postponing surgery if you are dealing with a depressive episode or significant life stressor. A divorce, loss of a loved one, job loss, or family discord can be very stressful, but more so if you are about to have surgery.

Minimize your post-surgery stress by choosing a date when things are calm in your life. There is no perfect time, but there are times when you need to heal before attempting significant life changes. Evaluate how much stress you have in your life. Ask yourself will having surgery at this moment contribute to feeling overwhelmed.

Talk to a mental health professional. Take a look at your mental health history.  If you have a history of severe clinical depression or have experienced hospitalization, you're at risk for relapse. Recruit both a psychiatrist and psychologist as part of your support team. Make an appointment with a mental health professional specifically to discuss changes in medication or planning for the first few months of change.

By merely bringing your fears to the forefront and discussing relapse, you are increasing the chance of a positive outcome. Develop a working relationship with a therapist. It's so difficult to be in the midst of a relapse and trying to find a good therapist. If you have an established relationship, it makes it easier to identify triggers and strategies to assist you from spiraling further.

Know the symptoms of clinical depression (see below).  If you see signs, don't wait to address it. Keep communicating with your treating physician about changes in mood and your psychotropic medication regimen. Do not be afraid to talk to your surgeon, therapist, or treating physician. People want you to succeed and are willing to work with you on your journey if you allow it.

How To Tell If You Have Depression After Weight Loss Surgery

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of a Major Depression Episode (MDE) requires five or more symptoms to be present within a 2-week period.

  • Depressed mood most of the day, nearly every day
  • Anhedonia—markedly diminished interest or pleasure in almost all activities most of the day, nearly every day
  • Insomnia or hypersomnia nearly every day (take sleep apnea into consideration)
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy (more than would be expected after surgery)
  • Feelings of worthlessness or excessive guilt
  • Diminished ability to concentrate, or indecisiveness
  • Recurrent thoughts of death or suicide
  • Significant changes in appetite (take surgery into consideration)
  • Irritability or increased somatic complaints without physical cause.

Depression After Weight Loss Surgery - Conclusion

The good news is pre-existing depression, and anxiety does not interfere with the amount of weight loss after WLS (Finks et al., 2011). Patients lost 60% of their excess weight within one year and reported an average of 30% improvement in overall quality of life.

With preparation and doing the groundwork, you can have a positive post-operative experience. Each weight loss journey is unique. Identify what you need to build a strong foundation for success. Preparation psychologically and emotionally will provide a quicker bounce-back time or prevent a depression relapse altogether.

The experience of WLS is a lifelong process and not a destination dictated by a number on a scale. With adequate preparation and consistent self-care, you will succeed in finding a healthier you.

References

  • American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
  • Burgmer R, Petersen I, Burgmer M, de Zwaan M, Wolf A, Herpertz S. (2007).  Psychological outcome two years after restrictive bariatric surgery. Obes Surg 2007;17:785–91.
  • Finks, Jonathan & Carlin, Arthur & English, Wayne & Giordani, Bruno & Krause, Kevin & Hawasli, Abdelkader & Birkmeyer, Nancy. (2011). Prevalence of psychiatric disease among morbidly obese patients undergoing bariatric surgery: Results from the Michigan bariatric surgery collaborative. Surgery for Obesity and Related Diseases, 7: 339–340.
  • Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, et al. (2010).  Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psych 2010;67:220–9. 10.1001/Archgenpsychiatry.
  • Omalu BI, Ives DG, Buhari AM, et al. (2007). Death rates and causes of death after bariatric surgery for Pennsylvania residents. 1995–2004. Arch Surg. 2007;142(10):923–928.
  • Sarwer D, Cohn N, Gibbons L, Magee L, Crerand C, Raper S, et al. (2004).  Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obes Surg 2004;14:1148–56.
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Bertha Rodarte

ABOUT THE AUTHOR

Bertha Rodarte, MA, PhD is a bilingual (English/Spanish) licensed clinical psychologist, specializing in health psychology. She earned her PhD at the University of Texas at Austin. Dr. Rodarte has over 13 years of experience with bariatric patients. She provides pre-op psychological evaluations for WLS and therapy for patients needing additional support.
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