Understanding Why Some Experience Postoperative Depression (And How To Cope)

Updated October 5, 2022 by BetterHelp Editorial Team

Medical professionals—surgeons, physicians, nurses, and others—know that there’s a risk of depression after surgery.

However, their focus is on healing the body.

So if you’ve had surgery recently or are about to have surgery, you may not have been informed that you are at risk for depression. Although we don’t know everything about why depression post-op occurs, several reasons have been identified. Here is what is known so far.

Postoperative Risk Factors for Depression

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Postoperative depression can happen to anyone. However, there are risk factors that make it more likely. First, some surgeries seem to be more closely associated than others with postoperative depression. Depression can occur after even a 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 for postoperative depression is pre surgical depression or anxiety. In fact, anyone with a history of mental illness is at greater risk for postoperative depression. Here are some other risk factors for depression, broken down by procedure and population:

For coronary artery bypass graft:

  • Being single
  • Being a smoker
  • Having anxiety before surgery
  • Having 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 Post Surgical Depression

You may have risk factors for postoperative depression, but that doesn’t mean you will definitely have depression post surgery. In fact, it’s not entirely clear what causes this condition or whether the cause is physical, psychological, or a combination of the two. However, scientists and doctors have hypothesized about what might be behind this phenomenon. Here are a few possibilities:

  • Post surgical pain
  • Surgical 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

Depression may also result from feeling vulnerable. When you undergo surgery, you put not only your health but your entire life in your surgeon’s hands. If the surgery involves general anesthesia, you have no sense of what is happening to you during the procedure. And it may disturb you to know that the medical team will see you unclothed.

Disappointment in one’s own body and health can also factor into postoperative depression. People like to see themselves as strong and healthy. So discovering that they have an illness or injury that requires surgery can make people feel like their body has let them down.

Finally, surgery can make you think about your own mortality. If you have gone through life feeling invincible, it can be difficult to consider that you may not live as long as you had hoped.

Signs You Have Postoperative Depression

Since most surgeons are laser-focused on healing the body, it is common to go through surgery and never be informed you’re at risk for depression. It is also common not to be assessed for post surgical depression as part of your surgical treatment plan. It may be up to you to educate yourself about the risk of postoperative depression. Here are some 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 right after surgery. After all, you expect to feel fatigued. If you’re in pain, you might attribute sleeplessness to that discomfort. And you wouldn’t be alone in thinking these things. Often, doctors miss post surgical depression because they assume symptoms of depression are related to physical rather than psychological aspects of the surgery.

What You Can Do to Avoid or Overcome 

Depression post surgery can affect both your mental and physical health. If you’re depressed during the post-op phase, your body may have trouble healing. In fact, postoperative depression has been linked not only to poor recovery, but also to death after heart surgery. So what can you do to prevent depression, or to deal with it should it occur? Here are some steps you can take.

Before Surgery

If you haven’t had surgery yet but are about to, 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, get enough sleep, and avoid substance use. If you’re feeling anxious or depressed before surgery, you’re more likely to have post surgical depression. So address those issues with a counselor before your surgery date.

Another helpful strategy is to get social support. Talk to friends or family members about how you’re feeling about the upcoming procedure. Discuss what you’ll need after the procedure. Include not only physical and practical help, but also social and emotional support.

Be Aware

After surgery, watch for signs of depression. Don’t assume that depressive symptoms such as sleeping too much or struggling with feelings or low self-worth are a natural part of recovery. 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, tell your doctor.

Do Some Journaling

Recording your postoperative journey serves several purposes. For one thing, if you write down your symptoms and feelings, you will have a map of your recovery that you can share with your health providers.But more than that, giving voice to your fears, sadness, and even joy can help you understand yourself better and manage difficult emotions.

Find Pleasant Ways to Spend Recovery Time

You’ll need some time—maybe days, maybe weeks—for your body to heal. Your movement may be restricted, you may be in pain, and you might have to follow dietary restrictions. If you have to rest or avoid strenuous activities, you may end up in bed a lot, which could cause you to dwell on past problems or future fears.

Finding pleasant ways to pass your recovery time will help counter depression. Get outside and sit in the sun. Listen to music, whether it’s old favorites, songs you’ve never heard before, or a genre that is new to you. 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

Trying too hard to be tough can increase your risk for depression.It’s important to talk to those you trust about your emotions and needs. Rather than suppressing your feelings, find someone to talk to about them. Be it a friend, a family member, or a mental health counselor, the important thing is to have someone to open up with your thoughts and emotions.

Get Validation from Others

It’s easy to doubt yourself when you’re feeling vulnerable or physically weak.Talk to loved ones about what you are experiencing. You need validation from others that what you are going through is real and matters. You may need help during your recovery, and you might not be able to do everything you usually do. You need to know that it’s okay to lean on others while you recover.

Talk to a Therapist

Surgery may be large or small, serious or minor, unexpected or well-planned. No matter what the circumstances, surgery can be traumatic and lead to depression. Talking to a therapist is a good way to deal with your thoughts and feelings about surgery.

You can discuss the impact of surgery on your mental health with a therapist from BetterHelp. All you have to do is answer a short questionnaire, and usually within 24 hours, you will be matched with a counselor and can start therapy. Postoperative depression happens, but it doesn’t have to last. When you have support processing your thoughts and feelings, you can recover emotionally as you recover physically.

Online Therapy Can Help with Depression After Surgery

A number of studies show that online therapy is at least as effective as traditional face-to face therapy in reducing symptoms of depression. One study showed that while both online and face-to-face treatment resulted in significant improvements in depression, only the online group maintained those changes three months after treatment. Another study showed no significant differences at three-month follow-up between the depressive symptoms of those who received face-to-face and online treatment. And a final study found that those who received online treatment for depression had significantly fewer depressive symptoms than a control group during a 10-week trial.


The Benefits of Online Therapy

As discussed above, online therapy with a licensed therapist is a great way to overcome depression. But when you’re struggling with symptoms like depressed mood or low energy, it can be hard to find the motivation to leave home. This is where online therapy comes in. There’s no need to sit in traffic or take time out of your busy workday to drive to your appointment; you can speak with your licensed therapist from wherever you have an internet connection. BetterHelp’s licensed therapists have helped people with depression. Read below for some reviews of BetterHelp therapists from people experiencing similar issues.

Counselor Reviews

“Kathleen is mindful and insightful. She actively listen to my worries and concerns and provides worksheets to help me with my issues.”

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“I’ve been talking with Rebecca since February and she has helped me immensely! A lot has changed in my life and she’s helped me create a positive mindset and space to navigate the changes and pursue the type of life and relationships I want. Along with this, she’s provided me with resources I can use outside our sessions.”

Commonly Asked Questions Below:

Is depression a side effect of surgery?
How long does depression from anesthesia last?
How long does post surgery anxiety last?
Is there such a thing as post-op blues?
Should I still be tired 4 weeks after major surgery?
How long does post surgical fatigue last?

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