Why Some People Have Depression After Surgery (And What to Do About It)

By Julia Thomas

Updated February 27, 2020

Reviewer Kelly L. Burns, MA, LPC, ATR-P

People in the medical profession - surgeons, physicians, nurses, and others - are aware that there's a risk of depression after surgery. However, their focus is on healing the physical body, so if you've had surgery recently, chances are no one told you that you could get depressed afterwards. Although why this happens isn't completely clear, several reasons for postoperative depression have been identified. Here's what scientists know so far.

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Postoperative Risk Factors for Depression

Depression after surgery can happen to anyone. However, there are certain risk factors that make it more likely. First, some surgeries seem to be more closely associated with postoperative depression. You can have depression even after a very minor surgery. But doctors have noticed that people who have the following procedures often have depression afterwards.

  • Heart surgery, especially coronary artery bypass graft
  • Plastic surgery
  • Gastric bypass surgery
  • Brain surgery
  • Hip replacement surgery
  • Radical prostatectomy
  • Mastectomy
  • Hysterectomy
  • Cancer resection
  • Vision correction surgery

All in all, the most significant risk factor is having depression or anxiety before surgery. In fact, anyone who already has a history of mental illness is more likely to have postoperative depression than those who have not. Here are some of the risk factors that have been identified in specific types of procedures and patients:

For coronary artery bypass graft:

  • Being single
  • Being a smoker
  • Having anxiety before surgery
  • High cholesterol before surgery
  • Having angina
  • Having more severe heart problems
  • Having a repeat procedure.

For radical prostatectomy:

  • Urinary problems after surgery
  • Bowel problems after surgery
  • Sexual dysfunction after surgery

In elderly patients:

  • Having depression before surgery
  • Having functional impairments after surgery

Possible Causes of Postsurgical Depression

You may have risk factors for postoperative depression but that doesn't necessarily mean you will end up having depression after surgery. In fact, no one really knows exactly what causes this condition or even whether the cause is medical or psychological or a combination of the two. Scientists and doctors have several ideas of what might be behind this phenomenon, though. Here are a few of the possible culprits:

  • Postsurgical pain
  • Results don't match expectations
  • Problems with anesthesia
  • A biological process
  • Increased dependence on other people
  • A feeling of loss after having an organ or body part removed

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Another possibility is that the depression happens because you're in such a vulnerable position when you have surgery. You're putting your health and perhaps even your life in your surgeon's hands. If you're put under general anesthesia, you have no control over what happens to you while the surgery is going on. And, it may disturb you to know that the medical team will see you without your clothing on.

For anyone undergoing surgery, disappointment in your own body and health can be a factor. People like to think of themselves as strong and healthy. So if they suddenly find out they have a medical illness or they are injured, they may feel that their body has let them down.

Another issue is that when you have a surgery, you may begin to think about your mortality. You were going along feeling invincible, and suddenly you have to come to terms with the fact that there's a possibility you won't live as long as you'd hoped.

Signs You Have Postoperative Depression

Since most surgeons are laser-focused on healing your body, it's very common to go through surgery and never understand you're at risk of depression. It's also common to never be assessed for postsurgical depression as a part of your surgical treatment plan. It may be up to you to decide whether to seek help for this type of depression. Here are some of the signs to watch for:

  • Trouble sleeping
  • Extreme fatigue
  • Hopelessness
  • Feelings of guilt
  • Irritability
  • Depressed mood
  • Loss of pleasure or interest in activities you previously enjoyed
  • Crying often or unexpectedly
  • Increased or decreased appetite
  • Low motivation
  • Thoughts of self-harm

It's easy to overlook symptoms of depression after surgery. After all, you expect to feel fatigued. If you're in pain, you might attribute any sleeplessness to that discomfort. And, you wouldn't be alone in thinking that. Often, doctors miss postsurgical depression because they assume the symptoms are related to medical aspects of the surgery rather than depression.

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What You Can Do to Avoid or Overcome Depression After Surgery

Depression after surgery can have negative effects for your mental and physical health. If you're depressed during the post-op phase, your body may not heal as well. In fact, postoperative depression has not only been linked to poor recovery, but it's been linked to death in the case of heart surgery. So, what can you do to prevent depression or deal with it if it comes? Here are some steps you can take.

Before Surgery

If you haven't had surgery yet but know you soon will, talk to your primary doctor as well as your surgeon about your risk of depression. This is especially important if you know you're in a high-risk group.

Also, prepare your mind as well as your body for the surgery. As much as you can, eat healthy foods, sleep enough hours at night, and avoid drug and alcohol abuse. If you're feeling anxious or depressed before surgery, you're more likely to have postsurgical depression. So, address those issues with a counselor before your surgery date comes.

Another thing you can do before surgery is to get social support. Talk to friends or family members about how you're feeling and what bothers you about the upcoming procedure. Discuss what you'll need after the procedure, not only in terms of physical and practical help, but also what kinds of social and emotional support you'll need.

Be Aware

After you get out of surgery, pay attention to any signs that you're becoming depressed. Don't assume that your symptoms are a natural part of recovery from this medical procedure. Don't shrug off a depressed mood, especially before or after surgery. If you're feeling sad or hopeless, those feelings need to be recognized and addressed. Be aware of changes in your emotions, appetite, and sleep patterns. And, if you notice any signs of depression, point them out to your doctor.

Do Some Journaling

Writing things down serves several purposes. For one thing, if you write down your symptoms and feelings, you have a map of your recovery that you can share with your health providers, Also, putting your fears, sadness, or emotional discomfort into words can help you understand yourself better and manage difficult emotions.

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Find Pleasant Ways to Spend Recovery Time

You'll probably need some time - maybe days, maybe weeks - for your body to heal. Your movement may be limited, you may be in pain, or you might have to follow dietary restrictions. If you have to rest or avoid strenuous activities, you may end up spending your recovery time dwelling on past problems or current fears.

The best thing you can do in this situation is to find more pleasant ways to pass that time. Get outside and sit in the sun. Listen to music, whether it's old favorites, songs you've never heard before, or a genre you've never listened to much. Read a new novel or revisit one you've enjoyed in the past. Play board games or card games with friends or family members. As you occupy your mind, you'll find it easier to stay positive.

Don't Bury Your Feelings

People who try to be tough and not reveal their emotional upset before and after surgery can easily become depressed. It's important to talk to someone about your needs, your fears, or your sadness. Rather than suppressing your feelings, find someone to talk to about them. Whether that's a friend, a family member or a mental health counselor, the important thing is to have an outlet for your negative thoughts and emotions.

Get Validation from Others

It's easy to doubt yourself when you're vulnerable or in a weakened physical condition. Talk to loved ones about the procedure, what you'll be going through emotionally, and how the surgery will affect you immediately afterwards. You need validation from others that, yes, this is a big deal. Yes, you may need help during your recovery, and you might not be able to do everything you usually do during this time. You need to know that it's okay that you can't do your usual activities or take care of your usual responsibilities while you recover.

Talk to a Therapist

Surgery is a traumatic event. It may be a large or small surgery, a serious or minor one, or it may be either an unexpected emergency procedure or well-planned elective surgery. Depression can happen in any of these situations. Talking to a therapist may give you a better chance of dealing with your feelings and thoughts about the surgery.

You can discuss your surgery and how it's impacting your mental health by going to BetterHelp. All you have to do is answer a short questionnaire and start therapy with the counselor of your choice. Depression can happen after surgery, but it doesn't have to ruin the rest of your life. When you deal with your postoperative depression in the right ways, you can recover your emotional well-being even as you recover physically.

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