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Postoperative Depression

Endometriosis and depression after surgery.

Two heads with thunderclouds and lightning inside them with a hospital separating them

By B. Neufeld

If you’ve ever had surgery, you know that it can be a stressful experience. For some patients, it goes much deeper than that.

Postoperative (post op) depression is not uncommon and yet it is rarely discussed with patients when doctors go over the risks of surgery.

Even when the surgery is successful, some patients are left feeling depressed or hopeless in the time thereafter. The following discusses possible causes of post op depression, how to identity the signs, how to best prepare to mitigate the risk, and where to turn to for support.

Symptoms 

Knowing the signs and symptoms of possible mental health issues can help lead to solutions quickly. So, what are the signs of postoperative depression to look out for if you or someone you know has had surgery? They include:

  • Difficulty sleeping
  • Extreme fatigue
  • Feelings of hopelessness
  • Feelings of guilt
  • Irritability
  • Depressed mood
  • Anxiousness
  • Loss of pleasure or interest in activities that were previously enjoyed
  • Frequent or unexpected crying
  • Increased or decreased appetite
  • Decreased motivation
  • Thoughts of self-harm

Some of the symptoms of post op depression mimic the expected side effects of healing from surgery like feeling tired or experiencing a decrease in appetite. However, if you or someone in your care is not feeling like themselves, or is observably struggling with any of the aforementioned symptoms, reach out to a doctor or a therapist. Given the current environment with the COVID-19 pandemic, more and more doctors and therapists are seeing patients remotely. Booking a therapy session over the phone or video chat can be a excellent option when a face-to-face appointment isn’t possible, whether it’s due to the physical restrictions during recovery, long-distance travel or remote necessity as advised by Canadian health guidelines.

What causes postoperative depression

Person sitting down with their elbows on their knees and hands, clasped together, up to their face

Doctors aren’t quite sure why some patients experience post op depression and others don’t. Surgery can be a stressful experience, especially if someone has never gone through one before. The what-if questions posed in the lead up to surgery related to endometriosis alone can be the cause of stress and anxiety: What if the surgeon doesn’t find anything? What if severe endometriosis is found? What if complications occur?

If a hysterectomy for uterine problems is performed, the finality of the removal of the uterus can be overwhelming, even if the desire to become pregnant is non-existent. This is especially true if surgery did not go as planned and one is forced to deal with this new reality unexpectedly.

Another cause of post op depression can be the medications given during and taken after surgery. General anesthesia can be rough on the body, including the brain. Medications taken to manage postoperative pain can affect mood as well. If poor reactions to certain pain medications have been experienced in the past, having a conversation with the doctor prior to surgery and developing an appropriate pain management plan can help mitigate that risk.

How to prepare before surgery

Knowing what to expect on the day of surgery and discussing what will be performed with the surgeon is another way to help prevent post op depression. Same goes for knowing what to expect throughout the recovery process. Speaking to a therapist about hopes and fears surrounding surgery, and sharing these with close friends or family, can also prove to be a helpful tactic.

I was aware of post op depression and anxiety but was not prepared for how severe it would be… even though my surgery was less complex than many others.

There is a chance that mood will be affected after surgery, even weeks into recovery, aim to keep stress levels low leading up to the surgery date by meditating, getting enough sleep, going for walks or another activity that promotes relaxation such as yoga.

For further tips on how to best prepare, check out ‘Preparing for Surgery’ on the TENC Blog and sign up for surgery support with The Endometriosis Network Canada.

Steps to take after surgery

While the body is healing, it is important to help heal the mind too.

For ways to accomplish this, The Endometriosis Network Canada (TENC) reached out to members of the endometriosis community for recommendations. Sharon suggests making time to get outside and going for gentle walks once cleared to reintroduce such activities by medical professionals. Another member recommends avoiding emotionally triggering movies or shows. Instead, choose to watch documentaries that keep the mind engaged and captivated.

While one may be feeling better post-surgery and eager to return to normality, patience is essential to allow the body and mind to fully heal.

“Take your time and slow down,” encourages TENC member Victoria. “I thought I would be back at work full time and back at the gym after a few weeks but wasn’t able to. Healing is a slow process and it’s not linear.” 

At the end of the day, there is only so much preparation that can be done surrounding surgery. Complications, including postoperative depression, can still occur. For TENC member Jen, dealing with post op depression was extremely difficult: “I was aware of post op depression and anxiety but was not prepared for how severe it would be,” she shares. “I had to take extra time off work and could not return full time for almost two months after surgery, even though my surgery was less complex than many others. I still struggled even then and worked only 4 days a week for many months.”

Monitoring for observable changes in mood or personality and knowing the avenues of support can make all the difference when coping with realities associated with mental health.

Finding support through community

Connecting with a doctor or therapist is a great next step to take when postoperative depression is suspected. It’s important to keep in mind that the first therapist may not be a compatible match. Being open to speaking with different therapists until a positive rapport is felt can be the turning point towards healing.

Additionally, reaching out to others who have gone through similar experiences can be extremely validating. There have been numerous discussions surrounding postoperative depression in The Endometriosis Network Canada’s private Facebook support group. A resounding message of advice frequently reiterated through posts and comments is:

Be gentle with yourself as you heal physically and mentally.

To better connect and support the endo family across Canada, TENC’s monthly Canada-wide and Toronto endometriosis support groups are now meeting virtually over Zoom. To learn more, contact TENC’s support team at support@endometriosisnetwork.ca or learn more about our virtual support groups.