Anyone on Depression Meds Currently or Was on Them Pre-Op???

I'm just curious...

I've been on Fluoxetine (generic prozac) for 2 years prescribed by my primary care physician. 

I'm not really depressed NOW at all and have never had to go for counseling before.  However, I am seeing a psychologist (Dr. Lelito) next month per the required protocol before I can have a surgical consultation.  That's the only medication I'm taking right now and I listed it on my psych paperwork that I have to bring in with me for my session next month.

Has anyone been had their surgical consultation and/or surgery delayed because you were/are on this type of medication?

I was on Fluoxetine and Wellbutrin before and after surgery.  And so much more.   There were no delays because of it.   Not from Lelito or Caruana, they were both fine with it. 

I was on Fluoxetine, then lexapro, then I was on Zoloft prior to having surgery for about 9 years before having WLS.

It was prescribed by my great PCP.   I switched every few years because it seemed that the depression came back after a while.  

I didn't have any problem with Dr. Lelito at the consult on taking anti-depressants. 

Now, I am happy, I don't take any anti-depressants anymore.   I am also on a lower dose of my blood pressure medication, I sleep better and feel much better. 

You will feel the same way after having your WLS.

This is the criteria "I" use for preop evals (your mileage may vary) I would say no being on Prozac in and of iteslef doesn't disqualify someone....

This may help clarify what clinical issues need to be reviewed to better assist in making recommendations regarding a patient's appropriateness for surgery. The following is a suggested list of criteria, based on MY experience, discussion with local surgoens and a review of the literature.

Exclusion Criteria:
1. Current drug & alcohol dependence/abuse (needs to be in remission 1 year).
2. Untreated and/or unstable mental illnesses: Depression, Bipolar disorder, Anxiety disorder, severe personality disorders or Thought disorders, need to be in treatment with minimal symptoms.
3. A history of near lethal or repetitive suicide attempts may require further evaluation.
4. Eating disorders: anorexia, bulimia, severe compulsive/binge eating with no ability to control intake.
5. Noncompliance issues & concerns (unwillingness to diet, exercise, or follow treatment recommendations).
6. Inability to give informed consent for treatment.
7. Inability to make lifestyle changes (ex. financially, psychosocially).
8. Unwillingness to follow post-surgical care.
9. Unrealistic surgical expectations, ambivalence about surgery or impulsiveness in decision-making regarding surgery.
10. Inadequate family supports or family hostility toward surgery.
11. Presence of unresolved severe situational stress that may interfere with patient's success/compliance: current divorce, job stress, financial issues or family issues.

Realize that the psychological evaluation is an important piece in the multi-disciplinary pre-operative evaluation of the bariatric patient, and I feel that a collaborative approach to exclusion criteria is imperative for success.

So all you can do is be honest! I wouldn't think based on your info here there would be an issue? Your depression is being treated w/ minimal/no symptoms...

Here is another intersting link on OH
http://www.obesityhelp.com/morbidobesity/information/wlsjourney/your+psychiatrist.php

I try and prepare patients ahead of time (when doing preop psych evals) NOT to go off their antidepressants for at least a year postop. This is due to a few factors. Depression is quite common believe it or not postop (whether or not preop one was diagnosed!).

First of all due to the loss of food and the grieving process we go through, however different for all of us, it is a stressful time as we learn alternative coping skills to deal with emotions where we once used food as a solution.

Secondly it is a time of HUGE change and not a good time to go off an antidepressant. Thirdly the hormonal imbalances/changes with rapid wt loss can cause a sever case of PMS/depression as estrogen is surged into the blood from the fat it was once stored it!

I posted this article earlier today but worth a read!
Depression after Bariatric Surgery: Triggers, Identification, Treatment, and Prevention
May 2008
by Cynthia L. Alexander, PsyD
http://bariatrictimes.com/2008/05/09/depression-after-bariatric-surgery-triggers-identification-treatment-and-prevention/

THANK YOU!!!

This information is very useful.

You are most welcome!

Was looking for the post I saw here a few days ago related to the percentages of bariatric patients who become depressed, or worse, decide to end their lives, and fortunately came across your very concise and informative post. Thank you for all the information, although in my case, the psych evaluation seemed less rooted in truly discovering my surgical appropriateness than it was just getting me in and out of the office in time, sad to say.

Prior to my surgery, my PCP had me on a titered dose of 60mg Cymbalta (slowly up from the original 20 mg) for situational and chemical depression. This was the first drug of it's kind to specifically handle what I needed it to, but along with many other things being forgotten along the way by the surgeon and his team (IE: never started my normal daily MS Contin dosage of 200mg 4 times a day back after surgery, so I began going through nasty withdrawals in the hospital), they never restarted my Cymbalta. When I asked them about it when being dismissed, they said I should just "go back on it when I was home."

Now, I have spoken about this with my PCP, who was not happy about me being taken off a lot of my important meds, and he was adamant I not begin back at that high a dose after almost a week off. Have experienced withdrawal in the past from Paxil (that was horrible!) but am not sure if Cymbalta is the same since the MS Contin w/d might have masked any other symptoms. However, along with what might be the "normal" feelings of depression after bariatric surgery, am wondering if my current overwhelming sadness, crying jags and more are elevated due to the infection and now resulting daily wound debridement and care at home. Just have NEVER felt this lost before.

Am going to definitely call my PCP back today after reading your post, and ask if they can start me back at a lower dose for starters, or what they think is best. Am also going to go read the article by Dr. Alexander you posted. This is an area which no one ever covered at all, at least not in my own personal experience, and information such as you presented should be made available to everyone. The less we feel "abnormal," the faster we can heal and move on ... at least that is my own personal hope for now, among many -- like for my pain to stop.

Thank you so much for taking the time to post all the information on this very important part of our journey for us, bless you.

Suzanne

Hello, yes Cymbalta has a discontinuation syndrome when stopping that can mimick that you had with Paxil, probbly not quite as sever, IN MY expereince I restart folks on 30 then go back to 60mg after 3 days or so, no real issue even with restarting 60mg, some get some nausea that is usually it, but do what your provider wants.
Beyond the Body Beautiful
Amy Taylor, RN
Monday April 19, 2004

http://include.nurse.com/apps/pbcs.dll/article?AID=2004404190319


http://www.medicalnewstoday.com/articles/92338.php
Mental Health Care Needed Before, After Bariatric Surgery, Says The Harvard Mental Health Letter

http://www.1gastricbypass.com/depression.htm
Depression - A Common Problem After Gastric Bypass
Weight Loss Surgery Associated With Increased Death From Suicide, Heart Disease
Tuesday October 16, 2007


http://depression.about.com/b/2007/10/16/weight-loss-surgery-associated-with-increased-death-from-suicide-heart-disease.htm


If you want more info let me know! Be well.
SSRI/SNRI Withdrawal Syndrome

The following criteria define the SSRI (or SNRI) withdrawal syndrome:

Criterion A: A course of treatment in which an SSRI (or SNRI) is stopped or
interrupted or the dose is reduced after a period treatment of 2 weeks or more.

Criterion B: Two or more of the following symptoms develop within 1 to 10
days of criterion A (except for fluoxetine in which case the symptoms must
develop within 28 days):

(a) dizziness or lightheadedness
(b) nausea and/or vomiting
(c) headaches
(d) lethargy
(e) anxiety and/or agitation
(f) tingling (parasthesias), numbness or "electric" shock-like sensations
(g) tremors
(h) sweating
(i)insomnia
(j) irritability
(k) vertigo (dizziness)
(l) diarrhea

Criterion C: The symptoms of criterion B cause clinically significant
distress or impairment in social, occupational, or other important areas
of functioning.

Criterion D: The symptoms are not due to a general medical condition or
the direct physiological effects of another substance (e.g., a
medication or a drug of misuse) that has been recently commenced, stopped,
or altered in dosage.

Criterion E: The disorder is not better accounted for by an exacerbation/
relapse/recurrence of the psychiatric disorder for which the SSRI was
prescribed.


Adapted from:
Haddad PM The SSRI discontinuation syndrome: literature review and
provisional diagnostic criteria. Presented at: XXIst Collegium Internationale
Neuro-Psychopharmacologicum Congress. July 12-16, 1998; Glasgow, Scotland.
Reprinted in International Drug Therapy Newsletter. 1998, 33, 46.
~~~~~~~~~~~~~~

Hibernation Syndrome


After WLS, you may be feeling tired and become depressed. When you are
several weeks post op, and are either on a liquid diet or you are
eating many fewer calories than you were pre op, this depression and
inactivity can become more pronounced. All you want to do is sleep, you
may have crying spells, you may begin to believe that the surgery was a
mistake, or you may think 'what in the world have I done to myself?'
All these feelings are completely normal and, to a certain extent, are
to be expected. The low number of calories you are eating produces what
many of us call the 'hibernation syndrome' and your depression and
feelings of despair, are a direct result.

During the weeks immediately following surgery, our body starts to
notice that we are not taking in enough calories. It doesn't know we've
had WLS, or that it's the year 2008. Our body is missing food, thinks
this is a famine, and struggles to conserve our energy. The human body
reacts like it always has in a famine; it makes us depressed--so we
don't have the motivation to do anything, and it makes us tired--so we
don't have the energy to do anything. In this way, we will conserve as
many calories as possible and remain alive. You can see the practical
value of this as our bodies have been living through famines,
snowstorms, and other periods of unstable food supply for centuries.

This stage can last several weeks. Our discomfort is compounded as we
are, at this same time, trying to recover from major surgery, adopt new
eating habits, and deal with a liquid or soft diet. To get out of this
stage, our body has to say to itself 'gee, this famine is lasting a bit
too long. If I keep conserving my energy with inactivity, I will starve
to death. I'd better use my last store of energy (the remaining fat and
muscles in our body) to hunt up some food'. At this point, our body
will switch from getting energy from food, to getting energy from our
fat (and muscle too if we don't eat enough protein) and that is what we
want.

In order to deal with this difficult transition period, tell yourself
that you're right on track; this is exactly what is normal and to be
expected. Tell yourself that, in a few weeks, this will pass, and you
will feel like a completely new person. We all seem to turn the corner
about 4-6 weeks post op. Then, your mood will lighten and, with your
weight loss starting to add up, you'll feel more positive and have a
better outlook on life. Just keep telling yourself that you will not
always feel this way! You WILL be back to feeling like your old self.
Just give it time!

Best regards . . .

Dear Amy (Hope that's correct, or is it Jamie?)

Once again one of your posts has brought some light through the tunnel of current darkness for me, and likewise my fiance this time since I read him what you wrote - while choking back tears of course. Will be reading your words each and every day they are needed, and probably even when they aren't! Have also bookmarked the sites I didn't have already so I can go to them when my pain level is lower.

My PCP called me back this morning to say he wanted me to go ahead back on the 60mg dosage, but let him know if there were any effects aside from all the usual suspects right now. Will wait until bedtime to take it though, that's when I used to take it, just in case it made me sleepy. Will be counting the days until it works again!

Doing all I can to make myself feel more in touch with the "real world" during some of the painful periods -- went in search of all the free protein samples I could find online last evening, and will probably add them to either the links on my Blog or do an individual entry -- maybe post them here. Yes, it's cool to have the VitaLady samples, but, with my income being what it is, plus all the medical bills to deal with, even paying what might be [for some] a "paltry" $1.99 each is too much for me. Plus, my equally frugal fiance was working out how much a profit someone could make doing that size sample per container, and was floored at their desire to charge that much. LOL, yes, we even compare the "price per oz./lb." tags at the grocery store!

Anyway, will just ramble on here if given the chance *g* ... so thank you again dear lady. Oh, and both my Mink Tonkinese and black short haired furry babies send you hugs too! (Am 'assuming' by your name you might like cats a little too!)

Warm Hugs & Blessings,

Suzanne/Suzywoo2