Postoperative Depression

Larger operations are perceived as very stressful by almost everyone. Often the physical complaints are in the foreground of the event in such a way that the psyche of the affected person can easily fall into oblivion. Unfortunately, in many hospitals mental health and operation management are ignored. Such impairments can strongly influence the progress of recovery.

This is often referred to as postoperative depression. In psychology and psychiatry in German-speaking countries, the term has not yet established itself. In the USA, on the other hand, the exact causes of depression after surgery have been researched for quite some time.

Definition

Strictly speaking, the actual term postoperative depression does not yet exist in specialist circles. However, the phenomenon is well known! Ultimately, postoperative depression is a reaction to a heavy burden in a person’s life. It is therefore more generally referred to as an adaptation disorder, also known as reactive depression.

In contrast to manic depression, for example, a concrete connection can be established between an event (operation) and the complaints.

Conversely, it can be assumed that without surgery no depression would occur in the respective patient.

Symptoms

Central symptoms can be depressed mood, joylessness, drive lessening or loss of interest. Very often, those affected are not in a position to put their emotional situation into words. They report a strange “emptiness” and numbness. The lowered interests concern mostly all ranges of the life, are it private, vocational or the daily political happening. For example, personal hygiene can also be neglected.

In addition, patients often have a “compulsion to brood”, i.e. their thoughts revolve continuously around the same topic without finding a solution. Relatives report that their affected relatives withdraw more and more. Hospital visits are hardly noticed and conversations become increasingly difficult.

Typically, the need for sleep increases enormously. Some patients oversleep in principle the whole day! Often the eating habits change, so that either no appetite is present any more or is eaten permanently.

Actually simple decisions such as the choice of breakfast can no longer be made and lead to a great indifference.

Postoperative depression or just exhausted?

Many sufferers and relatives are unsure when it comes to distinguishing between post-operative depression and “moodiness” or “exhaustion”. Many people automatically feel unwell when they think about operations or hospitals.

If the symptoms described above occur, many of those affected blame the operation and the resulting physical discomfort. The loss of appetite is explained by the side effects of the medication, fatigue with the after-effects of the anaesthetics or listlessness with pain in the operating area.

To a certain extent, the descriptions often apply. Large operations are an enormous physical challenge!

However, if they exceed a certain degree or proportionality, postoperative depression can be considered as a diagnosis. Of course, the time frame is also decisive. If the symptoms appear immediately after the operation and subside within a month, there is no need to worry. However, if the symptoms last longer, perhaps even years, it may be post-operative depression.

Prevention

In order to prevent the onset of the disease, patients can take a number of supporting measures before the operation.

The central point for many patients is the feeling of fear.

Uncertainty and a lack of ideas about the time after the operation cause great uncertainty. It is therefore highly recommended to have detailed discussions with the attending physicians and surgeons. Ask any questions you may have about the postoperative period!

Out of shame and fear, many patients simply do not dare. Sometimes it can help to be accompanied by a friend or relative during the consultation. In addition, it is advisable to note down important questions, because in the excitement aspects can be quickly forgotten.

Ideally, you will be able to get an accurate picture of the time after the operation and will not run the risk of being thrown back by excessive expectations. Speak openly about the fear of suffering from postoperative depression! In this way you already sensitize your environment and do not run the risk of being overlooked.

Friendly or family relationships are extremely important for the time after the operation. It can help to plan fixed visit rituals before the operation and to create structure. In all hospitals there are also pastoral staff who offer unsolicited talks.

During which procedures is postoperative depression particularly frequent?

Since the anaesthetics are of great importance for the triggers of postoperative depression, there is a higher risk for operations performed under general anaesthesia than for operations requiring only regional or local anaesthesia. In addition, the risk is greater with larger and longer operations than with small operations. However, it has not been possible to reliably prove the existence of special procedures that generally present a higher risk of postoperative depression.

Therapy

A postoperative depression can be treated differently and the therapy is adapted to the severity of the symptoms. First of all, it is advisable to seek an open discussion with the doctor. Relatives often notice the changes first and contact the specialist staff. Sometimes detailed discussions with the treating physician are sufficient, but a psychotherapist/psychologist can also be called in.

Frequently, those affected are already relieved when the problems are discussed. It can help to establish the connection between the operation in the sense of a life-changing event and the current psychological condition. Memories of earlier successfully overcome life crises can also give the patient new strength. Antidepressants are the main medication used.

How long does postoperative depression last?

No general statement can be made about the duration of postoperative depression. In some patients there is only a brief episode of depressive mood after the operation. This often lasts only a few days to a few weeks. In some cases, however, depression also occurs after an operation, which persists for a long time and requires treatment with psychotherapy and medication if necessary. On the one hand, it is possible that a first depressive episode is triggered by the operation.


On the other hand, people who have already suffered from depression may experience a recurrence of the symptoms during the operation. The question of the duration of a postoperative depression is made more difficult by the fact that many connections in this field are still unclear and there is a need for further research. In any case, it is advisable to seek help for a longer period of postoperative depression (e.g. more than two weeks). Contact persons can be, for example, the family doctor, a psychologist or a counselling centre.

Bottom line

Postoperative depression is a serious clinical picture. In our society, psychological complaints are unfortunately often put behind physical well-being. Out of shame and fear of stigmatisation (“to be put in drawers”), many sufferers deny their suffering and thus enter a vicious circle. It is therefore extremely important to distinguish between postoperative depression and normal fatigue. Because only if therapy measures are taken in time there is a chance of improvement!