Mental Illnesses, and surgery?

I was wondering if people with mental illnesses, got approved for surgery? For example I have depression with psychotic features, would I need to tell the psychologist about this diagnosis? I'm in treatment but I just wanted to know if there was anyone else out there with the similar experience.

You want to be open about it and give it consideration when considering which procedure to get. If you were to get RNY or DS, for instance, the malabsorption component of these surgeries may affect how your psych meds are absorbed.

I can't recall anyone ever being denied because of mental illness, but a plan of continued therapy and watching effects of meds has been recommended.

I know the idea of not getting approved can be terrifying, however it's better to be denied and alive than to get approved while having issues which could cause you possible permanent harm. And yeah, it happens - people get approved who shouldn't and will eat impulsively, not follow vitamin schedules because they can't due to their illness, and so forth. Most bariatric psychologists are also sensitive to the fact that many of us have a history of trauma and/or mental illness, even just some slight depression, and they do not expect us to be 100% hunky dory, necessarily. We typically do not become obese because everything is alright with us.

And, people with depression get approved for surgery all the time, even with psychotic features. What is screened for is a lot of stuff, so this is a gross generalization: but basically they look for the ability to follow a regimen, like a major diet change, and also the ability to stop from acting impulsively. Bipolar disorder untreated can be very dangerous post-op if it is untreated. The question is how well your symptoms are managed and how serious it is. I've seen people get surgery with mental health issues which were poorly managed. It harms our outcomes at best, and at worst, it's dangerous and potentially fatal.

Having said that, I was also concerned about my psych approval. I have BED and major depressive disorder and disclosed both upfront with the psychologist. And my BED was severe, like I eating 30,000 calories daily severe. I was still approved because my eating disorder has been in remission for quite some time, and because I had put my best into my treatment and recovery. I hadn't had a binge episode for quite some time before surgery.

I was also approved with the stipulation I would continue my counseling and psychiatric care. Additionally, because I knew I was at risk for denial, I signed a release with my therapist so they could speak to the bariatric psychologist. One thing that might help is if you are in treatment, you could ask your providers if they'd be willing to speak to the psychologist doing the assessment. My therapist's observations (this was the therapist that got me from over 750 to my "svelte" 440ish pre-op weight) were very useful for the psychologist who assessed me since he had been my counselor for quite some time.

It is always best to be honest for surgery, because the after-care can be very hard for those of us who struggle with mental illness. The stress can cause us to relapse, and the hormone dumping also is definitely not a fun time. I have never had mood swings, and the hormone dumping gave me severe and intractable mood swings that were disturbing and incapacitating. I was able to get help quickly when it happened because I was up front with all my providers. They prescribed progesterone to counteract the estrogen dumping from rapid weight loss. This was good because since they knew I had mental health issues, they didn't touch my psych meds, and I was immediately stable after the hormone crap was sorted.

Thank you for the very well explained response. I'm sure it would be best to just mention the depression part, but because I want the sleeve done. I don't think I'll have to worry about the malabsorption.

Why only mention the depression? Because I don't think my delusions are that severe. Yes a doctor would be able to gauge that better, but I know myself well enough to know I'm better than before.

It's always up to you, because it is your mental health :) I completely understand where you are coming from, as I was unwilling to discuss my eating disorder for similar reasons. If they are well-controlled you don't need to worry about it.

However, just remember that a big trigger for delusions is stress, and surgery will push your stress to the limit. It's very stressful and difficult, and this means you may have more depression and also far more delusional thinking despite being treated. Don't hesitate to get the help you need in advance and also after surgery.

I am not trying to minimize the delusions. From our perspective as providers, they are actually quite common, at least in the populations I've seen and worked with. Many people struggle with them, actually, and you are definitely not alone! You are not the first person with them to get surgery by any stretch of the imagination, either. When I get a client with delusions I am respectful because I know 1) it's an illness and it's not them as a person and 2) like literally delusions are really common, seriously. I don't view them as any worse or better than depression. They just are what they are.

Re: malabsorption - we are still vulnerable to malabsorption with a sleeve because we eat very small amounts of food. We don't often get it, but it happens, actually. It is vital with any mental health issues to stay on top of it for that reason. We can have B vitamin issues which affects the brain/nervous system and mental health too because most of our stomach is permanently removed. The stomach makes a substance called intrinsic factor which we need to break down B12. I've seen many sleevers get vitamin deficient. Not the majority for sure, but more than you'd think. Much more common with a DS or SADI/SIPS, but it can still happen with a sleeve. You must be very on top of your nutrition.

Heard my surgeon say at his seminar that mental illness doesn't rule out surgery, but he would require that your illness is being controlled.

Working in the mental health field, I can honestly tell you that neither of your diagnoses will rule out the surgery. HOWEVER, you need to be very upfront about your diagnoses and how well they are controlled. Also, ask to see the bariatric psychiatrist, psychologist or social worker (depending on the program) early in your program and not 4 weeks before surgery. Along with that, sign a release of information so that your present therapist and the bariatric therapist can speak openly about what is good and right for you.

I don't think they will deny you the surgery, but they may change your program a bit to make certain that you are stable prior to surgery. Don't forget, surgery will worsen the delusions, no matter how well-controlled you are, because of the effects of the anesthesia. So make them aware of everything and be brutally honest with them.

I have bipolar II with a tendency towards anxiety, as well as a bit of OCD. I had no trouble getting approved for surgery-- in fact, my normal psychiatrist wrote me an approval letter, and I didn't have to work with a different provider for a pre-op assessment.

I agree with the other posters that you'll want to discuss your mental health and any medications you take, if any, with the rest of your medical team during the surgery process. But honestly, I never found that it held me back through any of the approval process.