Jul - Aug 2012

Depression Before and After Surgery BACKUP

By Cynthia K. Buffington, PhD


Morbid obesity increases the risk for a number of obesity-related health conditions, including psychological issues. Studies find that the majority of morbidly obese pre-surgical patients are depressed and that such depression not only causes relationships with family and friends to suffer but also contributes to further weight gain and disease.


Depression alters the production and activity of specific regulators of appetite and food preference that may contribute to emotional overeating, binge eating, sweet cravings, and other eating patterns that may increase food intake and body weight. Furthermore, voluntary muscle movements and the desire for physical activity are reduced by depression, lowering the number of calories your body burns and the risk for weight gain.


Depression also affects health status. Studies find that individuals who are depressed and undergoing psychological distress are at increased risk for heart disease, hypertension, cancer and other obesity-related diseases. Furthermore, psychological distress increases the risk for surgical complications and a lengthened period of recovery.


Surgery resolves or improves psychological distress and many of its causes and associated effects, for example, health problems, reduced mobility, low self-esteem and social discrimination. Over time, however, some patients experience a reoccurrence of their depression or develop such, along with those conditions that may contribute to weight gain, such as eating abnormalities (sweet cravings, binge eating, emotional overeating) and a reduced desire for movement and activity.


The causes for depression post-surgery are multi-factorial.  Possibilities include: 1) the inability to use overeating as an emotional crutch, 2) changes in relationships with family and friends, 3) the persistence of issues prior to surgery that brought about emotional distress, 4) an inability to cope with stress, 5) a lack of balance between work and play, and 6) a change in neurochemical balance post-surgery that may require medication or medication dosage readjustment.


Nutritional deficiencies post-surgery may also contribute to depression. Calorie restriction or malabsorption may cause a reduction in omega 3 essential fatty acids and research shows that deficiencies in this important fatty acid contribute to depression and anxiety. Surgery can also lead to deficiencies in certain other vitamins known to contribute to depressed mood. These include deficiencies in vitamin B12 and folate.  With all types of bariatric surgical procedures, folate deficiencies have been reported and B12 deficiencies may occur with gastric bypass and, to a lesser extent, the sleeve gastrectomy.


Therefore, depression post-surgery may have both a psychosocial and physiological basis and require one or a variety of interventions for improvement and/or resolution. Such interventions may include: 1) laboratory assessments of nutrients status, a nutritious diet, and regular use of supplements, 2) readjustment of anti-depressant medication and dosage, 3) evaluation of emotional issues and professional therapy, 4) development of coping skills for psychological distress, and 5) lifestyle changes that allow for relaxation and balance (play).


If you should start to feel depressed or ‘blue’, make certain you are being compliant in taking your supplements and following your dietary regimen. Have your labs checked for deficiencies in nutrients that may increase your risk for depression (omega 3, B12, folate). And meet with a behavioral professional to work through any emotional issues, eating disorders, or for correction of an underlying neurochemical imbalance. Depression IS harmful to your health, reduces life quality, and may interfere with long-term weight loss success. Take action against post-surgery depression!