The Surgical Complication No One Talks About
By Jamie Mae Wright, MD/PhD Student and HA Volunteer
You are on the road to recovery after yet another surgery but suddenly you find yourself unable to focus. You go back to school or work but have to escape to the bathroom throughout the day to cry. You don’t know what triggered it. One minute you are sitting at your computer working and the next thing you know you are thinking back to being in the hospital, the pain, the fear, the unknowns about the future and suddenly you are overwhelmed by emotion.
You lay in bed thinking back to the surgery, was there something I could have done differently? Will it happen again? Or in the case of hydrocephalus, when will it happen again? You get to sleep and then you wake up before your alarm for no apparent reason just to be hit with emotion all over again. And at the worst moments, you wonder if you will ever be able to achieve all that you had hoped to do. You wonder if hydrocephalus and the surgeries will make your dreams impossible. You wonder if it is worth the fight. You start to lose hope.
Those of us with hydrocephalus are often all too familiar with the risks of surgery. But there is one surgical complication that is seldom, if ever, mentioned before or after surgery, post-surgical depression.
It is not surprising that major illness, hospitalization and surgery can trigger depression in someone with a history of the illness, but it can even trigger depression in someone with no prior history of it. It can strike even weeks after the surgery, when you think you are finally getting back to “normal”. Many things about surgeries can cause depression. They are often a harsh reminder of how fragile life is and for those of us with hydrocephalus, it is a life dependent on a medical device and brain surgery. There are other things too though. The difficulty of getting normal sleep while in the hospital. Having to be away from home, school and work. The stress of impending medical bills. These are all things that on their own cause a certain amount of stress.
Studies have found that there may be more to post-surgical depression than just a normal reaction to stress though. It is important to recognize post-surgical depression and treat it quickly. Depression has been associated with a poorer outcome after surgery. While we know that hydrocephalus and brain injury can affect cognitive function, depression can also impair your ability to think, remember information, focus on a task and learn new things. Research has shown that depression can even make you more susceptible to infection. Pain and headaches, a common problem with hydrocephalus, can also be made worse by depression.
With all the potential negative effects of post-surgical depression, it is important to recognize the symptoms and seek treatment quickly just like you would for any other post-operative complication.
The signs and symptoms of post-surgical depression include:
- Difficulty getting or staying asleep, or waking up early
- Poor appetite or eating more than you usually would
- Not being able to concentrate or focus your attention on even simple tasks, such as watching TV or reading a news article
- Not wanting to participate in activities you used to enjoy, such as being with friends and family
- Feeling like you don’t have your usual energy or interest in things
- Feeling hopeless and helpless
- Feeling like your family or friends would be better off without you
If you recognize these symptoms in yourself or a loved one after surgery, it is important to talk to someone about it and get help. This can be your primary care physician, your neurosurgeon or neurologist, your minister, priest, imam or rabbi, or if you already have one, a psychiatrist or psychologist. In addition, most colleges and universities have Counseling Centers that offer mental health services. There are also hotlines and online services available if you need to talk to someone immediately (see links below).
There are also things you can do at home to help prevent post-surgical depression or improve it if it does occur:
- Try to keep a normal sleep schedule and routine. This is hard to do in the hospital and when combating pain and headaches but try to get back to a normal routine as quickly as possible after surgery.
- Take a walk. It is amazing how revitalizing a nice walk outside can be after surgery. You should avoid strenuous exercise immediately after surgery but getting up and walking as early as possible has been shown to actually help people recover faster. Just getting out of the house can do a lot for your mood, and exercise is known to help combat depression.
- Eat your fruits and vegetables. It is tempting to turn to comfort foods after surgery but eating healthy is important to both physical and mental health.
- Call a friend. Social connection is essential to our well-being. Even if you don’t feel like it, go to that movie or party. You’ll be glad you did.
- Talk to someone about it. Don’t isolate yourself or worry about what others will think. Let someone in.
- Keep a gratitude journal. Write down 3 things each day that you are grateful for. Studies show that it improves mood and helps prevent depression.
Remember, hydrocephalus is a condition that affects your brain. Your body, and your brain, have been through a lot and it’s okay to need help sorting it all out. And most importantly, you are not alone.
- National Suicide Prevention Lifeline
- American Foundation for Suicide Prevention
- Anxiety and Depression Association of America
- Depression and Older Adults
- American Association of Suicidology
- Assessment of Behavioral Distress and depression in the pediatric population