How does having a severe mental illness affect surgery?

I'm just starting the WLS process and I'm really concerned about how my mental illness is going to affect getting approved. I was diagnosed with Bipolar 1, PTSD, severe depression and anxiety. I see a Dr regularly and I'm on medication to treat my mental illness and am stable for the most part. My phsyciatrist thinks surgery is a good idea and thinks that it will help me A LOT! She and my other Dr's are supportive. I'm worried about the pshyc eval. Has anyone had problems getting approved because of a mental illness? Even though it's controlled? 

Hi,

I enjoyed reading your post.  Very well thought out.

I manage my bipolar 1 with seroquel only.  I tried so hard to take lamictal but it gave me wicked migraines each time I tried to titrate up on it.  oh well... that said,

I also find that managing my sleep is the single most important thing I have to do.

BUT, unlike you, I do not run hypo and seldom seldom get hypo any more.  For me, it only takes an increase of Seroquel to head off any mania.  There are a lot of antimanics that you could use when you start to see yourself get too high.

I am more worried about getting depressed.  I can't take antidepressants and I can't take lamictal so I am pretty much stuck with hoping the seroquel will be enough to keep me from getting severely depressed.

I am going to talk about all of this with my psychiatrist next week and also will be finding out if she is going to be supportive of this decision or not.  She is SMO so I hope she doesn't let her own weight issues affect her judgment about mine.

Has anyone talked to you about how continuting on Seroquel after your surgery may affect your weight loss?  I know one person who did loose 100+ lbs while staying on Seroquel, but I do worry, espeically since it was the Seroquel and other psychotropics that put this darn wieght on me to start with.

Good luck to you.  It really sounds like you have your ducks in a row.

Becky (approved pending pre-ops) in NC

I have depression and anxiety too and have been under a Psychiatrist's care for many years.  For me the surgery was a life saver.  Literally.  As for my mental health...it's an ongoing journey.  I have new issues to handle now but with therapy and meds, I am doing better than I have in a long time.  I've gone from a size 26-28 to a 4/6 and I no longer have the self-hatred that I had when I was fat.  I remember the guilt, pain and shame that came with that and it's gone. 

I think that you are wise in considering all this BEFORE you have surgery.  Be aware of how you're thinking, acting, etc.  maybe journal throughout the day so that you can "see" if there are any red flags.  I don't know but I can say this much...having lost the weight did NOT fix my life...it fixed my health and some of my self esteem issues but it also brought other factors into my life that I had not dealt with before.  A word of warning...if you have issues with substance abuse WLS can make you an alcoholic in a blink of an eye...there is transference addiction (alcohol instead of food, plus it takes less to feel it).  It doesn't happen to everyone but I had the genetic factor and previous alcohol abuse history so I had to come to terms with the fact that I am an alcoholic too.  I have been sober for 16 months and while it's been an extremely painful journey it's been one of the best things that ever happened to me.  Doesn't make sense when it's said like that but in my case, it's true.

Stay close to your support system and doctors.  If you feel as if your doctors are not listening to you...find someone that will.  I really, really recommend a good therapist if you haven't already got one.  I have tried several and it's like buying that wonderful pair of jeans that make your ass look fabulous, you have to try MANY, MANY pairs to find the perfect fit!  lol.

Hugs,
Susan

PS:  PM me if you need to talk...

I have been in psychotherapy for almost 20 years.  I began therapy to deal with my eating disorder, because I was gaining weight, and my husband was not happy with me at all.  It was not my weight that was the problem in our marriage, it was my personality disorder and other issues, but I had no clue about those things.  I could not deny my weight.

Well, I eventually learned of my alcoholism, and my need for medications.  Initially my diagnoses were Depression, Eating Disorder NOS, and Borderline Personality Disorder.  My psychiatrist only recently added Bipolar Disorder to the list.  

When I sought WLS, I had my psychiatrist do the psych evaluation for it.  He conferred with my psychotherapist, as they used to work together back when I first started therapy.  They both have known me for almost 20 years, and have seen my struggles and successes, along with my divorce, and my completion of graduate school.

I was once told that the key thing that the surgeons are looking for is stability of your symptoms.  If you are unstable, you will be unable to be compliant with the rigors of the discipline required to get through the first year of changes in diet and exercise.  

My suggestion would be to get into individual psychotherapy for yourself, if you are not already.  Also, examine your motivation to eat, and your self-esteem issues.  These have been huge triggers for me in the past 18 months as I deal with relapses into alcohol and other behaviors.

Remember that the surgeon will be operating on your stomach, not changing the way you think about food.  That must come from support groups, therapy, and other outside means. 

Trish

I too am bipolar, have PTSD, and severe anxiety attacks on a regular basis. Unfortunately, I lied to my surgeon about my mental health issues and realize now that I probably was not the best candidate for wls as it resulted in cross addiction and certainly did not bring me the joy I thought it would. While I am no longer obese, I have developed many new health problems and did not find the "joy in life" that I mistakenly thought being thin again would bring me.
That said - I think the difference for you is that you are communicating honestly w/ your psych and the surgeon. Several things to pay close attention to are keep in mind the malabsorption factor as it may impact how your medications work for you. And, keep in mind the frequency which wls patients - in particular women - tend to develop cross addictions are wls.

I have the same mental illnesses you have and was approved right away.  From what I was told is they wanted to make sure I was compliant in taking my meds so they knew after surgery  I would be compliant taking my vitamins.  My psychiatrist also said the surgery would help me immensely.  Good luck in your journey..  

I started my WLS in Oct of 2008 and after my 6 months of following the program, the TEAM at Hershey said that I need to wait and reapply in another 6 months due to my depression.  My therapist who I have been seeing for years could not comment on weather or not if I should have the surgery or not.  However, he felt I was not in the right place at that time to have it done, due to personal relationship within my marriage.  Yes, there are issues between me an my husband, but I feel it has to do with my weight.  But, I felt that I have been properly medicated and are handeling the issues.  THere was no concern for any other life change such as divorce in the near future, but I think they felt there might be. So they decided to hold me off.  

So, I decided to go to another Surgeon, and I am so glad I did, This surgeon is much better! THat is another story.

I have been on Cymbolta for many years and am finally on the right dose.  WHich if anyone is reading and can answer a question I have regarding medication.  I was told by one surgeon that I would have to change my medication because it is not crushable, but other surgeons have not stated anything.  I will be asking him when I see him next time, but was just wondering if anyone has heard the same thing? 

Well, to answer your question, if you really want the surgery and to be happy, I would sugest you be truthful with they therapist that will evaluate you for the surgery. You might have to wait just a little longer than usual if they fell that you are not ready.  I even had an outside surgeon give me a clear bill of mental health and forward that on to Hershey, but they would not even consider it. 

Good luck and hope everything works out! 

About crushing medication: Yes, according to what I was told, any medicaiton that you can't crush has to be changed. HOWEVER, most medicaitons take a while to get out of your system, and as in my case, you may be able to skip that medication until you are past the phase where you need to crush them. But to be sure, you need to talk to your psychiatrist about it, and you need to ask your surgeon about it as well, so you can know how long you would need to be off it.

I also, am diagnosed w/ BiPolar disorder, which is well managed. I had no problem with getting approved with my surgeon once he got the psych evaluation from my psychiatrist.