What is postoperative depression? Why it happens and how to cope

When you schedule surgery, you may be prepared for the physical challenges you’ll experience as you recover. However, you might not be aware of the mental health concerns that can arise after a procedure. 

Minor to intensive operations can lead to periods of inactivity, physical pain, and stress, which may cause or worsen symptoms like low mood, lack of motivation, and fatigue. If these feelings or symptoms persist, you might be experiencing postoperative depression. This mental health condition can significantly affect your emotional well-being and ability to move forward from surgery. 

What is postoperative depression?

Postoperative depression is a mental health condition that arises after a surgical procedure. This condition is not listed officially in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, it is a real phenomenon that can impact people from any background.

Also called post-surgical depression, postoperative depression has similar signs and symptoms to major depressive disorder, including but not limited to the following: 

• Changes in appetite and energy levels

• Low mood 

• Fatigue

• A sense of hopelessness or despair

• Difficulty concentrating

• Lack of interest in previously-enjoyed activities 

What causes postoperative depression?

Scientists are still unsure of the exact causes of postoperative depression, but some potential contributors include:

• Pain following surgery

• Changes in cognitive function after the operation 

• A high amount of stress before, during, or after the procedure

• Poor sleep and nutritional changes after surgery

• A prior history of depression or other mental health challenges

Some research suggests that general anesthesia may also contribute to postoperative depression. Anesthetics are potent medications, and while they’re essential for many major surgeries, they may cause temporary mood alterations after a procedure.

Treatment for postoperative depression

Depression is typically treated with medication, psychotherapy, or a combination of both modalities. There are several types of medication for depression, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants. However, consult a medical doctor before starting, changing, or stopping any medication, supplement, vitamin, or treatment for depression. After surgery, you may experience medical complications, so it can be crucial to be in contact with your doctor in case of any new or worsening symptoms, whether related to depression or other concerns. 

A therapist can also provide you with emotional support as you navigate the challenges of postoperative depression. They can guide you in identifying other sources of depressive symptoms, comorbid mental health concerns, and coping strategies that may work for you as you move through this stage. If your depression seems to last in the long term, therapy can be a long-term resource, aiding you with all types of life challenges. You do not need to have a mental illness or diagnosis to talk to a therapist or to better your life, and over 41.7 million US adults currently see a therapist, with the number rising every year. 

How to cope with postoperative depression

Postoperative depression can present unique challenges that other forms of depression may not, potentially preventing you from utilizing specific coping strategies. Still, there are several techniques you may incorporate into your everyday life as you recuperate from an operation. Your physician can help you determine which of the following methods best works with your plan. 

Prioritize rest

Rest can be a crucial aspect of recovery from surgery. It can also be vital to your ability to foster mental wellness. Sleep disruptions are common after an operation, and they can exacerbate depressive symptoms. Depending on your specific surgery and your doctor’s instructions, you may benefit from spending more time sleeping or resting at home. Whatever your situation, experts often recommend sticking to a regular sleep schedule of seven hours a night for adults. 

In the first few days (or weeks) after your surgery, your routine might become disjointed as you adjust to changes. However, as you regain physical strength, re–establishing your usual schedule—including your bedtime, waking routine, and mealtimes—may help you connect more profoundly with yourself. A regular sleep schedule can help you decrease depressive symptoms and rebuild the energy and strength to recover fully from an operation.

Practice mindfulness

The association between your mental and physical health is often significant, and studies show that it may be a crucial part of your ability to recover from surgery. In a 2017 study, researchers found that preoperative psychological health influenced physical healing in patients with surgical wounds. Mindfulness—a form of meditation focused on helping individuals foster a sense of presence—can help you take advantage of the mind-body connection. 

Mindfulness has been shown to decrease stress, lower blood pressure, and reduce pain—benefits that may alleviate depression and contribute to the healing process following surgery. In a review of studies, researchers found that mindfulness interventions improved sleep, enhanced physical function, and decreased depression in participants who had undergone a procedure. 

You can utilize a brief mindfulness exercise while sitting or lying, making it a potentially convenient practice when recovering from surgery. Consider the following steps:

1. Focus on your physical and emotional sensations and feelings while breathing deeply. Are you happy? Bored? Restless? 

2. Take note of your surroundings, focusing on the sensations they produce for you. 

3. If you notice your thoughts drifting from the present, try to bring them back gently. If you notice pain, acknowledge it. 

4. Identify five blue items in your immediate environment and focus on their shape, size, and sound, breathing deeply in and out for five counts each time. 

5. Repeat the meditation with any variation of the above tips. 

This increased awareness may help you quiet your mind, relax, and better tap into the mind-body connection by grounding you in your present moment. 

Connect with your support system

Support from friends and family members can be crucial after surgery. Your loved ones may be able to provide you with emotional support and more tangible forms of care, such as cooking meals for you or completing your household chores. In addition to having someone help you with daily tasks, you may find it beneficial to have friends visit you throughout the week, particularly if you feel lonely or down at certain times.

If you don’t have a social support system, consider joining an online support group for people experiencing depression or people who have recently had surgery or health challenges. You might find that talking to people over a video call can be as meaningful as having someone in person to talk to. 

Note that a common symptom of depression is social withdrawal. However, trying to connect in some way can be vital, even if you’re only texting or calling a friend. You might also try joining a group, calling a hotline, or talking to someone you haven’t contacted in a while. A mental health professional, like a therapist, can also be a significant resource for support. 

Practice self-care 

Some people who experience significant physical health challenges struggle to engage in care tasks, which can lead to worsening depressive symptoms and other complications. As you return to a more consistent routine, pay special attention to self-care, which can include any activity that nourishes your body and mind. Tending to personal hygiene, eating regular and nourishing meals, and engaging in activities you enjoy can help you show yourself compassion on the road to recovery. 

Stay active

While rest can be crucial as you recover from surgery, experts often recommend participating in physical activity to some degree after your doctor has given you the go-ahead. In addition to helping with recovery from surgery, exercise can alleviate depressive symptoms. Physical activity can release mood-boosting endorphins, ease pain, and provide you with a distraction from complicated feelings related to your procedure, depression, or other concerns. 

Your physician can help you determine how much exercise is healthy, given the type of surgery you underwent and your specific circumstances. Physical activity does not have to be high impact to positively impact your mental health, and research suggests that even walking regularly can improve or prevent depression. 

Navigating postoperative depression with support

You’re not alone if you’re struggling with depression after surgery. However, it can be challenging to reach out to a therapist in person when you’re in bed or unable to operate like you used to. If you’re living with mental health concerns following an operation, you might consider connecting with a licensed therapist online. 

With an online therapy platform like BetterHelp, you can work with a licensed mental health professional remotely. It can be convenient because its remote nature allows you to meet with a therapist from home and may be more cost-effective than traditional therapy. 

In addition, a growing body of research suggests that online therapy can be as effective as in-person treatment options when addressing mental health challenges like postoperative depression. For instance, researchers in a 2020 study found that an online therapy program led to significant reductions in depressive symptoms and a higher quality of life-based on a clinical trial of 460 participants. The study also notes that online therapy can be more affordable and convenient than in-person therapy and can effectively treat other mental health challenges, like anxiety.