Depression -- or is it?

[ouroborous 519]

So those who've read my posts know that I asked a lot of questions before surgery about post-op depression, and have had a few struggles since my surgery with the problem. I've had a lifelong history with depression and anxiety, and have at various points in my life done therapy and been on just about every medication known. None of those things worked, long term.

Note: some people do suffer real physiological depression post-op. It is well documented, and you should always talk to your doctor if you're struggling. I'm just posting my findings so that some of you might have a head start in unraveling this ball of twine.

What I'm finding is that my depression is almost entirely related to physiological factors. In short, when I take care of my physical needs adequately, I'm not depressed or anxious. In fact, when I'm getting enough sleep, food (especially carbs -- yes, the evil carbs!), Water, and exercise, my mood is very, very good. When I AM taking care of myself, I'm calm (not anxious), hopeful, and generally a pleasant person.

However, any of the following will QUICKLY put me into a tail spin:

1. Not getting enough sleep. I don't know how many times I'm going to have to re-learn this lesson, but for posterity, here it is: if I don't get enough quality sleep, I'm a wreck. This is getting more pronounced as I get older, and has gotten dramatically more pronounced since the surgery. It used to be that it took a week or two of crappy sleep (or not enough sleep) to bring me down. Now a day or two and I'm a wreck.
   
2. Not getting enough exercise. This is intimately tied in to sleep; when I am exercising regularly and vigorously, I sleep better. But even if you take sleep out of the picture, exercise has worked better for me than any antidepressant I've tried, and it has worked quicker. Don't get me wrong, I'm a big fan of better living through chemistry; if you need AD's, take them, but for me, exercise is much more effective. It can nip an anxiety attack in the bud, and 15 minutes of brisk walking in the sunshine (or even in the gray... come on, this is Seattle!) can prevent an entire day of blue moping.
   
3. Not eating enough. If I don't eat enough food, or good enough food, I am a mess. I get wobbly and cranky and prone to irritability and depression. Worse, I tend to compensate-eat later, and eat far more calories (and far worse calories) than I would have if I'd just forced myself to eat properly to begin with. Also, I've noticed a strong correlation between mood and carbohydrate intake in particular. I guess it makes sense; taking in far fewer calories means I have far fewer reserves to spare, but quite often snapping out a blue funk is as easy as drinking a glass of skim milk (which has both Protein and milk sugar -- a win/win combination of carbs and Protein, according to my nutritionist).
   
4. Not drinking enough. This doesn't make me blue, but it makes me feel ill and grumpy, and that often leads to OTHER bad behaviors that precipitate blue-ness.
   
5. Drinking too much caffeine. Of course, overindulgence in caffeine is always a shortcut to feeling icky, but since my surgery I've found that my tolerance is much, much lower. One big cup of coffee can make we wired and jittery for hours, followed by a deep crash of exhaustion and depression and anxiety. It's almost not worth it anymore.
   
6. Drinking too much alcohol. Similarly, alcohol is a depressant so this shouldn't be that surprising. What's surprising is how much stronger the effects are now. Particularly, unfortunately, the negative effects -- two or three drinks and I'm hung over, moody and anxious the next day. Just like caffeine, it's to the point where the "fun" is almost not worth the cost.
   

None of this means that I can avoid other good mental hygiene, like keeping social contacts strong and so forth. But ultimately, I find that simply taking care of my body -- doing the things I should be doing anyway -- is the most potent antidepressant available. It's as simple as this: when I take care of myself, I don't get anxious or blue. When I don't, I suffer.

[kbl 3]

though i am not one who has depression... what you posted makes a lot os sense just to feel good in general. i guess it is back to the basics..... we just need to take care of our selves. kelly

[Mattsgirl1 0]

Are you taking reglan post op? The Nurse Practioner at my bariatric surgeon's office said that the reglan will most likely make you more depressed. She said that if I get depressed while taking reglan during the post op phase, call my pcp and get my lexapro increased temporaily!

Hope this helps!

[Lisalu 89]

Ourborous,

As someone with along-standing mixed anxiety/depression disorder, I hear you loud and clear. For me the good habits and meds go hand in hand, much like VSG and good eating habits. Before meds, no amount of sleep, exercise and eating right would have sustained my mood. I'm just too disabled off meds. With meds, those good habits make a really big difference. The exercise, especially, helps with the anxiety immensely.

When I had my psychological visit before surgery, the psychologist asked if I knew VSG wouldn't make my weight disappear. I told him that I thought the VSG was going to be like antidepressants for me: necessary to achieve my goal but not sufficent in and of itself.

[TwoStepsBack 15]

Ouroborous,

I concur with everything you said. Having tried every medication and therapist available to me I finally had a breakthrough with CBT (Cognitive Behaviour Therapy)

What it made me understand is that feelings, thoughts and actions all affect each other. By changing one, the others will follow. So if I'm feeling really down and that makes me want to lay in bed and feel blue, I should do the exact opposite because positive actions make for positive feelings and positive thoughts.

It seems obvious, but when you are stuck in a negative cycle it is so easy to miss.

I am a pre-op who is also nervous about how my depression is going to pan out after surgery. But I feel that if I stick with my meds (Fluox 40mg/d) and watch my behaviour, keep active etc, then everything should be fine.

All the best, and I hope you continue to do those things which you know you need to :thumbup: xx

[Tina 0]

I appreciate your post...helps put things in perspective for me since, I too, have been experiencing anxiety and depression since my sleeve. I'm going to focus on the tips you've listed to see if that helps before trying to "get on something" to alleviate some of the symptoms I've been having. Thanks...its amazing how through this forum we can alter course of events with simple sound advice. Much appreciated!! :thumbup:

[Swiftflow 6]

Just out of curiosity have you looked into Seasonal Affective Disorder? I only ask because Seattle is not known for its sunshine, and you may work mostly indoors. Some people swear by the lamps that can help allieviate this when they work Night shift or see very little sunlight. Not saying I know much about it personally, but it may be worth checking into.

Seasonal Affective Disorder (SAD) Symptoms, Treatment, Causes and Facts by MedicineNet.com

[BlackBerryJuice 349]

I had a very different experience with depression back in 2005. When I first started feeling blue, I thought I could turn things around by making healthy changes, basically, same stuff you outlined in your post. However, it didn't work, and over the course of a few weeks I deteriorated to the point where every time my alarm went off in the morning, I'd start bawling. Getting out of bed to go to the washroom was something that would require two hours of convincing myself to do it. On days I made myself get out of the house, I was having obsessive thoughts about crashing my car into houses and trees every time I was behind the wheel. I even didn't have an appetite - the only time in my life I didn't have an appetite and didn't have some sort of stomach bug to blame! Thankfully, I took the step of going to see a counselor and then a shrink and went on Prozac, which made an amazing difference in only 2 weeks. So while taking good care of yourself with proper nutrition and sleep is very important, the significance of pharmaceutical intervention should not be underestimated.

[Qured 3]

Ouroborous,

I really enjoy your posts.

Ok, about this particular post. I liked the way you put things into perspective. It's actually a very holistic approach. Treat your physical needs first and the rest will follow, or at least the rest can follow. I think it's very important to keep that in mind at all times. I don't think that we realize that clearly how our body affects our emotional/mental wellbeing.

I've struggled with depression/anxiety for many years and through Gestalt psychotherapy, which is a very holistic approach, I actually started being more connected to my body and my emotions, which overall has helped (too much thinking never did me any good after all). Now, only 2,5 weeks post op I'm finding out that I've somehow got the skills to handle the blue-ish days.

[breezy 8]

I like the way you express yourself, too, ouroborous! You seem very intelligent and thoughtful. I have had problems with anxiety and depression since I hit puberty. My family has a significant history with chemical imbalances (brother schizophrenic, another brother bi-polar, mother anxiety) so no one can tell me that I should control my problems with only a upbeat attitude. Again, only speaking for myself, I take Prozac to help with the imbalance, but have learned many other things about myself to help understand what triggers me, and how to take better care of myself.

My oldest son told me that he has found that "when you tire out your body, your mind will follow." I have found that he is right. I, too, am doing hard yard work (shoveling, mowing uphill, etc.) and aerobic exercising to tire my body and am seeing that it helps with the depression/anxiety. I also have had to learn to listen to my body more to give it what it needs, as well as learn to set personal boundaries with friends/family to protect myself.

Anyway, thanks for your post. I'll be thinking about your list to see if I need to be aware of any triggers that you have shared.

[ouroborous 519]

So, nobody should take my posting as a recommendation to avoid meds. I am not anti-meds -- not at all. Better living through chemistry, baby (I mean, come on, I paid 20 grand out of pocket to have my stomach sliced up instead of "just" dieting and exercising; would someone who is anti-medicine do that?) I thought I was really clear about that, but I'll say it again: you really need to talk to your doctor about depression, and if you need meds take them.

That being said, the point of my post was that, for me, taking meds has never been as effective as remembering to take care of my physical needs. I don't know how many people are like me, but I don't always "remember" to take care of myself, but I always, always always pay the price. So I have to consciously remember to get enough sleep, eat enough healthy food, drink enough Water, etc. And one of the prices I pay if I don't do those things is depression and/or anxiety.

I suspect that for a lot of us, depression worsens after surgery. Not because of fear of mortality or anything deep and psychological like that, but simply because our brains are part of our bodies, and if we're not taking care of our bodies, we're not taking care of our brains! It's amazing how many people forget that they are a "part of" their physical selves and think that they can neglect their basic health and still keep firing on all cylinders, mentally and emotionally. I don't know about you guys, but I just don't work that way -- especially since the surgery.

So, if you need meds, TAKE THEM. But also, try to take better care of yourself -- do all the things you know you're "supposed to" be doing -- and see if that doesn't help at least a little.

[breezy 8]

When I made the comment about "no one can tell me that I should control my problems with only a upbeat attitude", I was thinking about another thread I read about taking depression meds after surgery and a member responded by saying "stop taking the damn pills." I know there are people out there that don't understand chemical imbalances and depression. I've also seen people who obviously need to get help, but will not because they don't want to take pills.

I didn't mean to suggest that you were anti-meds, ouroborous. What I DID mean to agree with is that it is a good practice to approach depression with listening to your body, as you have tried to do, to find out what you may be doing that is adding to the problem. Caffiene (sp?), food allergies, drinking enough Water, exercising, and also healthy a mental response. I've read a lot of self-help books that have taught me about co-dependence, boundaries, and dysfunctional thinking patterns.

It makes sense to battle depression from all sides, using all the tools in the toolbox.

Edited August 17, 2010 by breezy

[BlackBerryJuice 349]

I suspect that for a lot of us, depression worsens after surgery. Not because of fear of mortality or anything deep and psychological like that, but simply because our brains are part of our bodies, and if we're not taking care of our bodies, we're not taking care of our brains!

There's a physiological basis for developing depression after surgery - there's a large number of serotonin receptors in your gut - which is why people tend to feel relaxed and happy after a good meal. When part of your stomach is removed, so are many of the serotonin receptors. As depression is an issue of interaction between serotonin and its receptors, this makes it more likely for you to develop depression. There's an entire medical field called neurogastroenterology that likes to refer to the gut as "the second brain" - it's becoming clearer and clearer that your stomach and intestines do much more than digest and absorb food. Unfortunately, this is a new field and our knowledge about this is still limited.

[breezy 8]

There's a physiological basis for developing depression after surgery - there's a large number of serotonin receptors in your gut - which is why people tend to feel relaxed and happy after a good meal. When part of your stomach is removed, so are many of the serotonin receptors. As depression is an issue of interaction between serotonin and its receptors, this makes it more likely for you to develop depression. There's an entire medical field called neurogastroenterology that likes to refer to the gut as "the second brain" - it's becoming clearer and clearer that your stomach and intestines do much more than digest and absorb food. Unfortunately, this is a new field and our knowledge about this is still limited.

Do you happen to know of any websites that might give some more information? Something not too techy? I'd like to learn more!

[BlackBerryJuice 349]

Do you happen to know of any websites that might give some more information? Something not too techy? I'd like to learn more!

This is something I learned about in school, so I had to look up some websites for you, but here's a few articles that are geared towards the general public - I didn't read too closely, but they seemed to make sense. There are theories that serotonin is closely tied to some digestive diseases, such as irritable bowel syndrome. We're covering gastroenterology in school in Sep-Oct, so whenever I learn something that might be pertinent to us sleevers, I will definitely share it. If you are interested in more in-depth stuff, there's always good old PubMed. I found a ton of articles in medical and scientific journals when I did a search on this for you, so there's no shortage of theories and data out there.

Emotional Eating ? Brain-Stomach Connection on ELLE

Gut feelings: System acts as second brain | The San Diego Union-Tribune

Stomach soothers: your gut is so busy it requires its own nervous system. Here's how to keep things calm, cool and trouble-free - Good Medicine - Natural Health Articles | Find Articles at CBS MoneyWatch.com