Postoperative depression

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Postoperative depression

To worry about the upcoming operation is quite natural. But why does surgical treatment sometimes bring not treasured relief, but alarm, loss of meaning in life, and even depression? How to help yourself cope with all this?

The development of medicine has led to the fact that today almost no one in his life is destined to avoid a disease, the treatment of which requires surgical intervention1. It happens that after surgery, the patient is faced with post-surgical depression, although she does not suspect it. Although this term cannot be found in the international classification of diseases, experiencing depression after surgery is by no means uncommon.

At the household level, depression is often understood as blues or a temporary rush of sadness, but real depression is a disease. And although today this diagnosis is being made more and more often, it is not at all a “disease of our time”. Hippocrates also described some symptoms of this condition: despondency, insomnia, anxiety, eating disorder – true, calling it melancholy. But Pifogor and Democritus recommended real psychotherapy: to conduct internal work, engage in contemplation and analysis of their own lives.

Today, we are following these two paths in the treatment of depression: medical 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 talk briefly about each of them.

Reactive depression

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

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

The basis of this type of depression is another disease – for example, traumatic brain injury, meningitis, previous intoxication, stroke. In this case, targeted treatment of the underlying disease is necessary, which triggered the disorder.

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

Signs of Depression

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

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

A person with depression functions according to other laws, and advice in the spirit of “positive thoughts” can only aggravate his condition

To this can be added the loss of interest in life, in usual work, and in what used to please us, 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 be a difficult and sometimes impossible task for a sufferer. Depressive disorder, as a rule, lasts at least two weeks, and in the most severe forms – for years.

It is important to realize that a person with depression functions according to other laws, and advice in the spirit of “thinking positively” and “don’t be lazy, believe in the best” can only aggravate his condition. The patient’s strength is running out, as if gasoline has run out in the car, and “pull yourself together” instructions increase guilt and shame, drive the sufferer of depression into a vicious circle of emotions: “I am a failure”, “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 those around him that everything is in order. “You underwent surgery, now everything is in order, believe in the best” and other attempts to “open your eyes to life” are unlikely to succeed, or may aggravate the condition of a person suffering from depression.

Postoperative depression

Why is it important to recognize postoperative depression?

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

Possible causes of postoperative depression:

1. Stress from physical intervention. 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 it hurts us, the whole body reacts to it: from the cardiovascular system to the spleen. Stress hormones – cortisol, adrenaline and norepinephrine are injected into the blood instantly.

2. Often, chronic diseases are literally embedded in the daily life of a person and his family. To be diagnosed is to restructure relationships not only with your body, but also with loved ones. For example, when migraine is healed, it may turn out that there was not enough time for yourself, because before a painful attack made it possible to rest somehow “so that no one would touch”, 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 benefits that the disease gave. To do this, you can ask yourself: what did these symptoms give me? What did they not let me do, what were they saving from? If I allow myself to live without the symptoms of the disease, what will change? Does something in these changes scare me?

3. The reason for the deterioration of psychological well-being may be painkillers or anesthesia. Although postoperative depression after anesthesia is not so common, it still occurs. Usually we are talking about a combination of factors, such as: preoperative mood, the nature of the surgical intervention, anesthetics and the postoperative state3.

At heart, we may have the thought that we seem to be completely out of the game called “life”

4. The operation and subsequent recovery are associated with a new rhythm of life, which means that you can not do without restrictions. The more indispensable we seem to ourselves and the more prone to perfectionism, the more we can respond to temporary disability and limitations.

5. Fear of death. When leaving the state of anesthesia, some say that they experienced intense visions of light at the end of the tunnel and experienced a near-death experience. Anesthesia is like a dream, but while it lasts, our body undergoes certain manipulations that are not amenable to our control. This fact alone can cause a surge of anxiety in those who are used to controlling everything or have experienced violence or abuse.

Who should shift the job responsibilities to? Who to leave the children with? We are trying to temporarily arrange life without our participation. In our hearts, we may have the thought that we seem to quit the game under the name “life”.

Arriving at the hospital, we sign documents that we are informed about possible complications and more sad outcomes. We leave a number for someone to contact 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, maturation 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. Birth, wedding, funeral – even in modern culture, these events are prescribed numerous necessary rituals.

Operation is also an important milestone in human 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 life for the better, to learn something new about ourselves, to discover an unknown source of strength in ourselves.

If we change the attitude in relation to 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.

If we consider the operation as an opportunity to recognize ourselves from a new perspective, there is a chance to move to a new stage of personal 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 it 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 know ourselves from a new perspective, to know the strength of our body and spirit, to go through pain, fear and endure, we have a chance to go to a new stage of personal development. Ask yourself the questions: “Who am I now?”, “Where am I going?”, “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.
Nadezhda Zheleznyak

about the author

Nadezhda Zheleznyak – Psychologist, author of the book “Cultural Therapy”. Her website.

Photo Source: Getty images

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