postoperative depression

The development of medicine has led to the fact that today almost no one in their life is destined to avoid a disease whose treatment requires surgical intervention.¹. It happens that after the operation the patient is faced with post-surgical depression, although he does not suspect it. And although such a term cannot be found in the international classification of diseases, experiencing depression after surgery is by no means uncommon.

At the everyday level, depression is often understood as a blues or a temporary surge of sadness, but real depression is a disease. And although today this diagnosis is being made more and more often, it is not a “disease of our time” at all. Even Hippocrates described some of the symptoms of this condition: despondency, insomnia, anxiety, eating disorders – however, calling it melancholy. And Pythagoras and Democritus recommended real psychotherapy: to conduct inner work, to engage in contemplation and analysis of one’s own life.

These two paths are still followed today in the treatment of depression: medication support, medical care and / or psychotherapy or psychological counseling, depending on the severity and type of depression.

Types of depression

By origin, depressive disorders are divided into three large groups. Let’s briefly talk about each of them.

Reactive depression

Depression can be triggered by a strong impact event – even a positive, but extremely stressful one. For example, the birth of a child, which is accompanied by fatigue, awareness of a new role, the inability to be alone with oneself. The event can be truly traumatic: death of a loved one, dismissal, divorce, relocation or surgery.

If the deterioration was preceded by an external, exogenous cause, then we are most likely talking about reactive depression. However, depression that has arisen as a reaction to an external event (for example, against the background of operational stress or under the influence of drugs) can pass into an endogenous state.

endogenous depression

There is still no consensus on the exact prerequisites for the development of this type of depression, but the origin of the disease in this case is biological – for example, an imbalance in the activity of serotonin, norepinephrine, and a decrease in the volume of the hippocampus.

Somatogenic depression

This type of depression is based on another disease – for example, traumatic brain injury, meningitis, intoxication, stroke. In this case, directed treatment of the underlying disease, which triggered the disorder, is necessary.

It is important to understand that it is not always possible to draw a clear line between these types of depression. It is necessary to contact a specialist: a psychotherapist or a psychiatrist – for qualified help.

Signs of depression

When diagnosing depression, experts rely on the so-called “depressive triad” or Aaron Beck’s cognitive triad:

1. A negative view of the future, or even its complete absence. It may seem to a person that he is doomed to experience these sensations forever and there is no way out. In the case of postoperative depression, worries that the operation may be repeated in the future and anxiety about health are added here. The subjectivity of experiences is an extremely important point: it may seem to the patient’s relatives that all the anxieties are practically empty.
2. Anhedonia (inability to enjoy), a negative attitude towards reality. Reality seems frightening, anger and a prolonged feeling of fatigue from others may arise.
3. Decreased self-esteem. A person blames himself for all the troubles, believes that he somehow attracted or deserved them. He boils in his experiences, memories of the operation, constantly thinking about whether it was worth doing it at all.

To this we can add a loss of interest in life, the usual work and in what used to please, a feeling of powerlessness in front of life. Any habitual action: getting out of bed, picking up a child from school, congratulating a friend on his birthday – seems to the sufferer to be the most difficult, and sometimes overwhelming task. A depressive disorder typically lasts at least two weeks, and in its most severe forms, years.

It is important to realize that a person with depression functions according to other laws, and advice in the spirit of “think positively” and “do not be lazy, believe in the best” can only aggravate his condition. The patient’s strength is running out, as if the car ran out of gas, and the instructions “pull yourself together” increase the feeling of guilt and shame, drive the depressed person into a vicious circle of experiences: “I am a loser”, “I am to blame for everything”.

A person in a state of depression subjectively sees the world in black colors. Objectively, it may seem to others that everything is in order with him. “You had an operation, now everything is in order, believe in the best” and other attempts to “open your eyes to life” are unlikely to succeed, and may even aggravate the condition of a depressed person.

Why is it important to recognize postoperative depression?

There is evidence that acute postoperative pain causes depression, which in turn lowers the pain threshold. Depression has also been associated with chronic postoperative pain. Many studies have identified depression as one of the risk factors for postoperative complications that slow down the healing process.².

Possible causes of postoperative depression:

1. Stress from physical interference. Pain is one of the most important biological mechanisms. It is thanks to pain that we can understand that something is going wrong, which means that we can correct the situation in time. When we are in pain, the whole body reacts to it: from the cardiovascular system to the spleen. The stress hormones cortisol, adrenaline and norepinephrine are instantly injected into the blood.

2. Often chronic diseases are literally built into the daily life of a person and his family. Losing a diagnosis means rebuilding relationships not only with your body, but also with loved ones. For example, when healing a migraine, it may turn out that there is not enough time for yourself, because before a painful attack made it possible to somehow relax, “so that no one touches it,” and now you need to learn to negotiate with your husband and family.

That is why it is important to compensate for the possible secondary benefit that the disease gave. To do this, you can ask yourself: what did these symptoms give me? What did they not allow me to do, what did they protect from? If I allow myself to live symptom-free, what will change? Is there something about these changes that scares me?

3. The reason for the deterioration of psychological well-being may be painkillers or anesthesia. Although postoperative depression after anesthesia is not as common, it does occur. Usually we are talking about a combination of factors, such as: preoperative mood, nature of the surgical intervention, anesthetics and postoperative condition³.

4. The operation and subsequent recovery are associated with a new rhythm of life, which means that limitations cannot be dispensed with. The more indispensable we feel to ourselves and the more perfectionist we are, the more we can respond to temporary disability and limitations.

5. Fear of death. When coming out of anesthesia, some say they experienced intense visions of light at the end of the tunnel and experienced near-death experiences. Anesthesia is like a dream, but while it lasts, our body undergoes certain manipulations that are beyond our control. This fact alone can cause a surge of anxiety in those who are used to being in control or who have experienced violence or abuse.

To whom should work duties be delegated? With whom to leave the children? We are trying to arrange life for a while without our participation. In the depths of our souls, we may have the thought that we seem to be completely leaving the game called “life”.

Arriving at the hospital, we sign the documents that we are informed about possible complications and more unfortunate outcomes. We leave the number of someone who can be contacted if something goes wrong. In addition, we can experience fear and even shame during preoperative manipulations.

Operation as initiation

Since ancient times, in all cultures, growing up has been accompanied by rituals of transition – initiations. They were necessary for the transition to a new stage and accompanied the most significant changes in life for a person. Births, weddings, funerals – even in modern culture, numerous necessary rituals are prescribed for these events.

The operation is also an important milestone in a person’s life. Often it leaves not only scars on the body – along with this event, something inevitably changes in the soul. We can use this event as an important turning point to change our lives for the better, to learn something new about ourselves, to discover an unknown source of strength in ourselves.

If we change the attitude towards surgical intervention, it turns from a frightening or even tragic event into an episode that allows us to rethink life, take stock and outline new ways of development.

It is no coincidence that the word “crisis” comes from the Greek “kairos” – “the moment of decision, the separation of light from darkness.” The Greeks called this the decisive moment that separates death from life and decides the outcome of the battle.

In the postoperative period, it is important to pay special attention to your body and inner world. Understand the meaning of the disease and the operation. That is, to fill everything that happened with meaning. If we consider the operation as an opportunity to get to know ourselves from a new side, to know the strength of our body and spirit, to go through pain, fear and persevere, we have a chance to move to a new stage of personal development. Ask yourself questions: “Who am I now?”, “Where am I heading?”, “After everything I have experienced, do I want to change something in my life?”.

^1. Two Hundred Years of Surgery, Atul Gawande.

^2. Depression and postoperative complications: an overview. Mohamed M. Ghoneim, Michael W. O’Hara.

^3. Scher, C.S., Faw, S.M., Anwar, M. The effect of general anesthesia on postoperative depression. Anesthesia & Analgesia. 1999, February 1999, Vol. 88, Issue 2S, p. 27S.