CaitlynR

If the sadness and other symptoms of depression is long lasting, intense, or interferes with daily life (work, relationships, self care), you owe it to yourself to see a professional for an assessment. Think about it this way: if you were feeling bodily pain of the same duration and intensity, would you get it checked out? If so, then treat mental pain the same way. One thing I've thought of is what happens to people who use alcohol or drugs to cope (whether they have an addiction or not) and then stop using. The very lack of a major coping tool that was effective for sadness and anxiety (regardless that this was a tool that hurt in the big picture, it can be pretty dang effective for a while) can uncover existing mood problems or simply make every day stresses much harder to cope with until the person forms other coping methods. I think most people in cultures with abundant food use food to cope with stress, sadness, anxiety, etc and those morbidly obese probably more often or intensely than average. Learning new coping methods is a fairly easy problem to solve. Recovering from a mood disorder is usually a bit more difficult but depression is a very treatable problem through therapy and/ or medication.

I have no expertise at all in working with people who are preparing for/ have had weight loss surgery.. To be honest, that was not at all part of my education or training, although I was in an excellent program. I think it is very rare, and I would question (in a neutral way) MH professional who claims to have expertise in this area. I suspect psychologists specializing in eating disorders (which I am not and will refer out for) may have more knowledge as there is some overlap (but of course only some, don't know the numbers but probably most prople who have WLS do not have a diagnosable eating disorder). That said, I think for most people, a good generalist therapist would be a great option. In my opinion, therapy just to vent is pretty pointless. Venting/ complaining is fine and often needed, but it is a starting point and staying there isn't going to get you much. Increasing understanding of your throught pattern, having someone highlight blinds spots, help you think through things and challenge unhelpful patterns? Ruling in or out a mood or eating disorder? Perfect. Abolutely I think there is a good chance it will be well worth the time and money. Just make sure the therapist is not a "support only" type, as I feel that kind of therapy feels good but doesn't really help. Support is a necessary but not sufficient element of therapy. The most helpful therapy is hard work. Disclaimer just to be safe: to be clear, I am wearing my personal/friend hat and not my psychologist hat on for any statements I make on here. Everything I say should be interpreted as something "Caitlyn who happens to be a psychologist" says and not speaking for the field of psychology, entering any sort of professional relationship with anyone, or intended to be any sort of professional assessment or treatment. (End ethical/legal disclaimer)

I find this discussion about therapy interesting and wanted to add my thoughts. I am a clinical psychologist (doctoral level) and work full time as a psychotherapist. I very rarely would say someone "needs" therapy. This may be more about semantics than anything else, but I may certainly recommend therapy, at times strongly, and would advise someone that therapy will likely be helpful or that I am concerned that without therapy there will likely be a lower quality of life, or higher risk of suicide or other poor outcomes. "Need" only typically is only mentioned in cases of imminent risk to self or others or legally mandated situations. This may mostly be a clinical choice as many people will give pushback to the more directive tone of "need" versus professional recommendation and encouragement. That said, I recommend therapy, many times without the heavy emphasis of a formal recommendation, very freely, both as a therapist and just a person. I very much believe in therapy, both as a practitioner and a client. I have no problem with others, with limited psych knowledge or knowledge about the person, recommending therapy. I believe many to most people can benefit in some way from therapy. There is very little risk, and cost is typically only in terms of money and time (versus medications or other medical options with a greater number and severity of potential risks and costs which must be weighed against potential benefits). The major risk I see is seeing a mediocre or worse therapist. I think educating yourself in advance on the basics of therapy and what to look for in a good therapist is very helpful so you know when you need to switch, as well as knowing sometimes someone is a great therapist but for many potential reasons are a poor fit for you in particular. A good one will not take offense at all for being asked for a transfer as our whole goal is for the client to benefit even if that is with someone different. One thing that I notice is that some people (not necessarily anyone here) will recommend therapy or say someone needs therapy in a way I feel reflects stigma of therapy or mental illness. The implication often is the person has a mental illness that needs to be treated by a professional (something that absolutely should not be determined by anyone other than a professional after a thorough assessment, and in my opinion a MH professional, but that's a separate topic). A similar implication is when it is known the person has a mental illness, and is told to go to therapy or take medications as a way of invalidating their current experience. In other words (the message is), if their emotions, thoughts or behavior are being attributed to a mental illness, they do not need to be considered as valid as those same emotions/thoughts/behavior displayed by someone without a known history of mental illness and the person should take care of this problem through treating it until it conforms to some standard the speaker holds. To take this a step further the implied message behind this can be the more harmful "wow, you have some serious problems/are being very irrational/'crazy', etc.". This is a way of distancing oneself and labeling the other person as in the category of "other" as opposed to the speaker and other normal/understandable/"sane" people. That kind of message can be extraordinarily harmful both in perpetuating societal stigma and increasing self-stigma. It is typically not intended to be harmful but hard to challenge as since it is formed through the lens of existing stigma and ignorance the person is likely to be defensive (such as when a unintentional but overt racist or sexist comment is challenged). In summary: it should be safe to suggest therapy to anyone if you feel therapy may be genuinely helpful. The OP is at the very least going through a time of adjustment and stress, with stated distress about current eating pattern, so I would recommend therapy as an option. Just make sure you don't tell someone (or imply) they have a mental illness or that what they are going through is part of a known mental illness (at least in the context we are talking here). Always try to be aware of your areas of limited knowledge and bias.

I am very happy to be here and have enjoyed reading this site over the past few weeks. I would love to get down some of my thoughts and hear any feedback anyone has for me. I tend to write essays so I apologize for the length. I am scheduled to meet with a surgeon in two weeks. I also have the psych eval and nutritionist appointment as well as some medical tests that day. The hospital is almost two hours away so I'm packing as much as I can into each trip. I have bcbs fep so still have the 3 months supervised program which has not started. I weigh 278 and have been around this weight or higher (highest around 300) for at least 10 years. I am 35, normal weight as a young child but as soon as I hit puberty quickly became obese. I am not saying it is all genetic, but I know that is part of it. My parents and brother all suffered with obesity or morbid obesity. My brother had gastric bypass surgery several years ago, and to make a long story short he had complications, and died two years after the surgery at age 30. This was not from the surgery but was medically fragile since the surgery. My parents blame the surgery although I do not. They have made it clear that they would be very, very upset if I chose bariatric surgery. Despite this, I have considered this for years. I try to base most of my major decisions on good data. I know that long term weight loss in significant amounts (like, 100 lbs) is quite statistically improbable. I have successfully kept 20-30 lbs (back and forth in this range) off for 6 years. Despite that I am concerned about my health. I have high blood pressure and take three medications to maintain this. I am in the prediabetic range for blood sugar. I see my dad with worsening neuropathy from diabetes type 2 despite really hard work on a very low carb diet. My paternal grandpa lost 3 of his limbs from this disease before he died. Despite being fairly young my knees are starting to hurt when using stairs. I worry that I won't have very long ahead of me. I honestly have come to terms with how I look and while being thinner would be nice, that is not a major motivation for me. Sickness and early death from health consequences of morbid obesity terrifies me. I work full time as a clinical psychologist at a Veterans Affairs. The work is my passion and I would not want to do anything else. However it can be very stressful. It is also very cognitively and emotionally demanding and therefore exhausting while being super sendentary. My salary also supports my family (son and sahd husband). I have recurrent major depression. I am doing very well, taking medication and when needed connect back with therapy. I always live with the fear of depression relapse due to fear not being able to keep up at work and how hard the last one was on me and my family (4 years ago). Fears: will such low amounts of calories allow me to have sufficient cognitive energy to do my job well? Will the mood effects bring on another episode of depression? Should I hide having surgery to my parents, which feels dishonest, or tell them the truth and live with their anger and fear of losing their only remaining child? Will I be able to regularly engage in moderate exercise which honestly I haven't done since my early 20's? If you made it to the end, thank you. I don't expect answers to the above questions but feels good to tell them to people who might relate. Any thoughts welcome. Any experiences of going through this while maintaining a demanding job are appreciated.

Thank you all so much for the outpouring of support, it means a great deal to me. I'll have a longer reply when I have more time but I wanted to share my appreciation.

Please consider a different sleeping medication. There are other options that work very well without the strange side effects, as well as risk of dependance, of ambien. You might consider asking your doc if trazadone or low dose doxepin would be appropriate. Another option is to find a therapist with an expertise in sleep disorders (not just a generalist). Good luck....I know from experience how hard insomnia can be.