Weight Loss Surgery and Depression

Hi everyone! I've been researching and considering WLS for years now, and am now at a point where I'm ready to meet with a surgeon to discuss it and start talking about it with friends/family, instead of just thinking about it. A friend raised a concern today that I was hoping I could put out there to those of you who may have some insight. 

As we all know, obesity and depression are commonly linked. At one WLS seminar I attended, they said that many patients who lose weight also find relief from their depression. Can anyone out there comment on that or share their experience with depression? 

My friend is afraid that I will go through WLS, lose weight, and still be depressed 5, 10 years from now which will cause me to gain the weight back. Or in other words, that getting the surgery is treating a symptom instead of the disease (the depression). I believe that I have mild depression, and I've been able to get it under control for the past year by taking St. John's Wort, exercising regularly (though I'm still a 43 BMI), and seeing a cognitive behavioral therapist from time to time. I'm also confident that if I discover that depression is still an issue after surgery, I'm honest enough with myself to seek out additional treatment (though I am hesitant to take medication). More importantly, if I die from an obesity related medical condition, it won't much matter whether I've been depressed or not. 

She, on the other hand, believes that if I aggressively treat the depression, specifically with medication, that I will naturally lose weight because I won't be depressed anymore. So she thinks I should come at it from the opposite direction, and retain my stomach. :) 

I realize that posting this on a WLS forum is going to skew the responses in my favor - maybe if I posted this on a Depression support website I would get answers supporting my friend's position. Nevertheless, I'd appreciate hearing from anyone who may have had this same question and found an answer after surgery. 

Thanks! 

I have bipolar. I was diagnosed when I was 16, and I've been on medication more or less since.

While my obesity was ultimately due to the fact that I ate too much, I noticed definite ties between my medication and my weight. There were several antidepressants that ended up in rapid, significant weight gain, and over the course of 10 years I gained a LOT. Weight gain is a generally-established side effect of many psych meds for many people (though the benefit may outweigh the weight gain for a lot of folks, myself included).

Since surgery, I do find that my mental health is a bit more stable than it has been in the past. I can't say for sure if it's because of losing weight, or because of my health habits that have changed since surgery. Probably a bit of both, honestly.

The bottom line is that this is your body, your health, and your decision. She's welcome to an opinion, but you are under NO obligation to consider it.

Treating depression is not going to make you "naturally" lose weight. In fact, a common side effect of depression medications is weight gain. And, yes, I was more depressed the more I weighed. I don't know how anyone can not be at least somewhat depressed when they can't find decent clothes that fit, they are discriminated against, they suffer from health problems, they are less likely to get promoted, and everything else that goes with being morbidly obese.

I am skeptical of all claims regarding "natural" weight loss. Once you have been significantly overweight for a long period of time, your body will do whatever it can to keep you at that weight. Here is a good video about it:

http://theworldaccordingtoeggface.blogspot.com/2015/02/time- to-act-on-obesity-video.html

I am a mental health professional and the studies I have seen indicate that the majority of people who are clinically depressed prior to WLS experience a decrease in depression during the first year, but their depression level returns to its pre-op level by about 2 years out.

It is easy to understand why the depression would lessen when people are losing weight very quickly, especially for those who have been obese for much, or all, of their lives.

There are a number of reasons for the return of depression, though (and it is often a combination of reasons). The biggest one is that most people are not just depressed because they are fat. That is far too simplistic.  When weight is only one of a number of contributing factors, just eliminating that one factor does not eliminate the others.  The depression doesn't "go away" during the first year, but the focus is  so intently on how quickly the weight is falling off, on getting in the vitamins, learning new eating habits, buying new clothes, etc..  The positive things associatedith losing weight just push the depression to teh abck temporarily.  Once life returns to normal, and people aren't so obsessed with adjusting to post-op life, so does the depression.

Sometimes people believe that losing weight is going to solve all their problems, because they think that many of their problems are partially or wholly caused by their weight.  Then they lose the weight and discover that they still have most of the same problems. They realize, for example, that their relationship problems have nothing to do with their weight... Or they realize that their own self esteem isn't any better just because their body is smaller. The depression then returns.

If the depression is partially the result of trauma, losing weight doesn't eliminate the effect of the trauma. In some cases, it can actually make it worse: if the weight was gained as a protective layer for someone who was sexually abused, for example, or of being a particular size triggers memories of abuse, assault, etc. that happened when the perish was that size before.

Another thing that can contribute to a return of the depression is people having unrealistic expectations about what their body will look like post-op or being significantly distressed by the amount of excess skin they have or not losing as much weight as they wanted.

I did a lot of research on this topic because I did a presentation on post-op psychological issues at a professional conference about 5 years ago.

Treating depression with medication rarely results in weight loss. (A few anti-depressant medications can actually cause weight gain.). That is because most weight gain is NOT just the result of depression. Your friend, unfortunately, is taking a much too simplistic view of obesity, the causes of obesity, and depression.  If her view was correct, none of the significant number of people here on Obesity Help who were taking antidepressants for long periods of time pre-op would have needed WLS.

Lora

I really like what Lora says here.  I too have struggled with depression for years and have no great ideas for it going away completely after my surgery.  I would really like to lower my daily medication some day, however, it's part of who I am.  I regularly see a counselor and am already adopting healthy choices even before my surgery.     Many things have changed for me in the last couple years...I got divorced which, at the time, was incredibly painful, but I have learned to become somewhat comfortable in my body now not having someone reminding me of my issues all the time.  I think WLS is a tool to gain a healthier life all the way around.  It's just one step in learning self-acceptance. 

I have depression and anxiety. I will say my depression and anxiety is better then it was. But it is still there.  I still have bouts where I feel like crap. I go to therapy 2 times a month to help me figure ways out of a dark hole where we can put ourselves.

My self esteem is a lot better. I do feel better physically.

Post op RNY - undignosed mineral or vitamin deficiencies can contribute or even cause depression. 

Low iron, B12, B1, proteins, etc.,  may cause low energy and depression like symptoms.. 

My mental health is significantly better now - but I attribute that to the fact that I've been working really hard to improve myself as a person, not just to lose weight. (I see a therapist weekly, I exercise, I meditate, etc, etc.)

So I sort of think that both you and your friend are right. Have surgery, work hard to lose weight, but at the same time work equally hard to improve your mental health. Don't expect the weight loss or weight loss surgery to be a panacea for your mind. 

Thank you so much everyone for the replies! What you say really rings true - I don't believe that surgery, or the weight loss that comes with it will "cure" my depression. I also don't believe that simply treating depression is an effective weight loss strategy. I'm glad that my friend voiced her concerns about my mental health, but I don't see it as a reason not to pursue this process. 

I have never had long term depression but I did have acute post surgical depression after WLS. 

I was a food addict and my source of happiness wasn't there anymore (because I couldn't eat much). I spent a month in my rec room.... but this was all acute depression. I didn't need treatment for it and eventually snapped out of things and went on with my life. I did add in a nasty little wine habit but the science suggests that transfer addition in former food addicts is very normal.... 

I have sorted that out now too - it is all a process of growing as a person and getting healthy! Because let's face it - when we are morbidly obese not many things in our lives are healthy choices (we eat poorly, we don't move out bodies enough) and perhaps we don't really put ourselves first! 

Good luck!