Countless people suffer from post-surgical depression for months on end, so why aren’t more people talking about it?
I have lost count of how many surgeries I’ve had in the wake of an accident that left me with internal injuries and scores of broken bones. I know the drill, how to prepare, and what to expect during recovery.
There are two fairly predictable but distressing things that I go through nearly every time. And even though I know about them, they catch me by surprise every time.
The first is that I usually experience a very intense spike in pain the evening of the second or third day post-surgery. It usually hits at the end of first day that I am starting to feel like the worst has passed. I have showered or dressed, begun the process of returning to some form of normalcy. There is no gradual build-up of pain. Instead, it feels like a tsunami of pain, utterly unexpected and devastating.
What makes the pain-spike devastating is that it is an expert liar. It tells me that something has gone terribly wrong, that my doctor has truly screwed it up, and it berates me for having given my consent. Above all, it tells me that I will never get out of pain. Every damn time, I fail to realize that this is that pain spike, believe the lies it tells me, and have a mini-meltdown.
The second thing that I can never seem to remember is that I am very susceptible to post-surgical depression. And like the invariable pain-spike, I never recognize it when I am dealing with it, and believe the lies it tells me.
Doctors have long been aware that many patients experience some form of post-surgical depression during the six months following an invasive procedure. But many physicians believe that being depressed after surgery is “understandable” and “unworthy of diagnosis or treatment.” Since most people with post-surgical depression emerge from depression after about six months, many doctors considered post-surgical depression either benign or even helpful since it keeps people inactive.
As a result, most people do not know that post-operative depression is a common complication of surgery. If it were as benign as many surgeons have assumed it was, perhaps this would not be such a problem. But researchers have discovered that depressed patients are more likely to have other complications. They are less able to cooperate in their after-care particularly in rehabilitative therapy. And for people like me who have an existing history of depression and anxiety, the recovery from post-surgical depression is neither guaranteed nor as straight-forward as some surgeons expect.
No one knows exactly why there is such a strong link between surgery and depression. Some researchers have hypothesized that many people experience post-surgical depression because it forces them to confront their own mortality. A theory that matches my own experience is that the length of time spent under anesthesia seems to be related to the likelihood and severity of depression.
Last summer I had a series of surgeries, and in the days following each I was hit by the infamous pain wave. Fortunately, my husband identified them and helped me through them.
But we both missed the signs of one of the most serious post-surgical depressions I have ever had. What made it especially difficult and dangerous is that I never felt depressed or sad.
The only time that I had overt depression symptoms was in the weeks before my final surgery. My family worried for a couple of weeks because of how desperate I felt. My pain had been poorly controlled and I could not bear the thought of another recovery in agony. Once I found a way of controlling pain, the desperation faded, and we assumed any depression had gone with it.
Instead, what followed was a growing belief that I had finally come to accept the truth of my life specifically and the nature of human existence in general. To put it in cliched terms, I was confronting my own mortality. But for me, it wasn’t death that I grappled with. Instead, I began giving a lot of thought to the fact that aging bodies are more vulnerable and that combined with our culture’s ageism, getting older is the steady and irreversible dwindling of options.
I believed the lies of depression when it told me that what I was capable of four months after a series of major surgeries was where I would be two years later. I gave away my bicycle and told my husband to sell our camping equipment.
When my doctor told me that I would need at least one more major surgery in the next couple of years, I did not obsess about it. Instead, I became obsessed with what might happen to my husband. The idea of him going through what I had endured was intolerable to me.
Yet it was all I could think about. I began to research the life-threatening illnesses I thought he might face. In graphic details, I imagined him grim-faced and stoic after open-heart surgery or anxious about learning how to orgasm again after prostate removal. At night while he slept, I checked his naked body for suspicious moles or growths comparing anything I found to online pictures.
My husband seemed incredibly fragile to me. I began to worry about how long he would be able to keep working in his chosen field of information technology. I thought of how he would suffer if he was unable to find a job. The poverty we might face paled in comparison to the sadness I anticipated him going through.
I stopped even hoping for a future filled with joy and meaningful work. Life began to look like one long, painful, and sad slog into the grave. I wondered every day how I could just “opt out” without hurting my kids.
Fortunately, my family knows about post-surgical depression. And although it took them a long while to recognize it, they were able to intervene before I fell over the edge. I began a new medication almost exactly six months after my last surgery. It was like a light came on, and suddenly I saw just how bad it had been.
The thing that truly frightens me in retrospect was how normal I believed my thoughts were. Somehow I thought that everyone spent time anticipating the worst, that everyone thought about suicide every day. I did not recognize the symptoms.
What also concerns me is how few people know about this common and dangerous complication of surgery. It worries me that people suffer without understanding why and that their families are not alert to the signs of serious danger.
We need to bring to post-surgical depression the kind of awareness that we have brought to postpartum depression. People going into surgery need to know that it is a possibility, and they need to have a plan in place in the event that they begin experiencing symptoms. I think that this is especially true for people with mental health histories. They need to know that there are additional treatments available in times of crisis. We also need to talk about post-surgical depression more widely so that the family members and friends of post-surgical patients can keep an eye out as my family did. And people who serve as the support system for post-operative patients should know how they can help the person recover.