Depression After Spinal Surgery & How to Overcome it
Feeling depressed after back surgery catches a lot of people off-guard. Postoperative depression isn't something that's widely discussed at appointments, in hospital handouts, and even between patients. However, a lot of people who have spine surgery report feeling depressed or have symptoms of depression during their recovery.
A study by the Mayo Clinic looked at over one million patients during a 10 year period. The study included only patients with "newly reported depression" (those who were not depressed prior to surgery) and found that "patients who undergo spinal surgery have a higher risk for postoperative depression than patients treated for other surgical or medical conditions known to be associated with depression." In other words, patients who have spinal surgery have a higher rate of depression (in the five years following surgery) than patients hospitalized for other surgical procedures (like a hysterectomy, cholecystectomy for congestive heart failure, or surgery for chronic obstructive pulmonary disease).
Spine patients who were not depressed before surgery were at least 1.5x more at-risk for depression in recovery than any other surgery patients involved in the study.
Depression after spinal surgery, and even depression after hip and knee replacement surgery, is real and quite common. In fact, in a study published in the Journal of Evaluation in Clinical Practice, nearly 50% of knee replacement patients reported feeling depressed after surgery. Although ongoing, severe, and diagnosed depression only affects a minority of patients, feeling "down" after any medical procedure is something most of us can relate to.
Interestingly, the study found that patients who underwent a fusion surgery or had multiple spinal operations had the highest risk of post-op depression.
Read on as we explain the link between back pain and depression, share why it's common for post-op spinal surgery patients, and offer some suggestions for what you can do to get back to feeling your best.
What is Depression?
Major depression and clinical depression will leave you with feelings of sorrow, prolonged sadness, and/or a general disinterest that is unexplained and lasts for an extended period of time. Depression affects your energy, mood, behaviour, desire to do things, sleep, and can cause physical symptoms (e.g. back pain). Depression can makes you and everything around you feel "blah".
Symptoms You May be Depressed:
Note: If you're experiencing some (or all) of these symptoms for longer than two weeks (for some or most of the day), you may be depressed. Always remember to talk to your doctor if you have depression and back pain symptoms.
Feeling sad/ anxious.
Feeling hopeless or negative about the future.
Feeling irritable and short-tempered with small things that may not have annoyed you before.
Feelings of guilt, worthlessness, or helplessness.
Loss of interest in the activities, friends, or hobbies that you used to enjoy.
Everything feels "meh".
Lack of energy and feeling fatigued (too tired to do things).
Physically moving slowly or talking quietly (a lack of enthusiasm).
Feeling restless, fidgety or having trouble sitting still.
Difficulty making decisions, focusing, or remembering plans etc.
Change in sleep patterns (e.g. insomnia, sleeping too much).
Appetite changes (e.g. lack of appetite or overeating)
Suicidal thoughts or attempts at suicide.
Here's a link to the Hospital Anxiety and Depression Scale (HADS). The HADS is a clinical test used by care providers to determine a patient's anxiety and/or depression. Use this test as a gauge, not as a diagnostic tool.
Depression and Back Pain: What's the Connection?
Without adding surgery into the mix, depression and back pain are inherently connected. It can be very difficult to determine which came first: depression then back pain; or back pain then depression. In other words, back pain is both a symptom of depression (a physical manifestation of emotional stress) and a cause of depression. For instance, suffering with chronic back pain and not being able to do the things one loves can make one feel like a lesser version of oneself, causing isolation and therefore triggering feelings of depression etc.
Here are some of the ways back pain and depression are linked:
Lack of sleep: Insomnia, poor sleep, and oversleeping are associated with depression. Those with back pain tend to have trouble getting to sleep and staying asleep. As a result, "clinical insomnia" is a symptom of back pain. Insomnia is linked to psychiatric disorders like depression.
Isolation: Chronic pain is isolating. When you're experiencing any form of pain you simply cannot engage in the same activities, work, or social situations you would like to. The more you stay away because of pain, the more you feel isolated. Withdrawing from the people and things you love is a cause and symptom of depression. Feeling lonely and isolated is common in those suffering from depression as well as those living with back pain.
Financial Stress: Similar to feeling isolated and lonely, if pain is affecting your everyday, chance are you cannot maintain your regular workload. For some, this may mean reduced hours and a paycheck hit. This can cause financial stress, feeling of worthlessness, helplessness, and guilt---these feelings are often shared with those suffering from depression.
Medication: Side effects of pain medication taken for lower back pain (LBP), spinal pain, sciatica, spondylosis, or chronic pain diagnosis can cause depression. Narcotic pain medication (like opioids) can cause depression.
Lack of Exercise: Exercise is an excellent release of endorphins. Cardio has been called "Miracle-Gro for the brain". However, when you're in pain, doing a lot of movement or cardio may be completely off the table. Without being able to engage in physical activity, you cannot reap the psychological benefits of exercise (reduced anxiety, stabilized mood, lower risk of depression).
To learn more, check out the full post "Depression & Chronic Back Pain: Symptoms and How to Treat it".
What is Postoperative Depression (After Spine Surgery)?
As we've explained above, the link between back pain and depression is indisputable. However, there are a lot of patients who go into spine surgery without experiencing pre-op depression (as observed in the study by the Mayo Clinic). Regardless of a history of depression before surgery or not, some form of post-op depression is quite common. If you think about it, since your physical and emotional well-being are connected, going through a traumatic physical episode (surgery) means that you may not just require physical healing. A period of emotional healing may need to take place as well.
Mani, a therapist and anxiety expert" underwent a knee replacement and described how surprising her emotional healing process was: "You don't hear as much about the fact that it took a month before I began feeling like myself...It takes a while to feel like yourself again. I didn't think I had my clarity of mind. It was a part of the recovery process I hadn't anticipated."
After surgery, here are the factors contributing to joint replacement post-op depression:
Reaction to anesthesia. According to Dr. Mary Shinn, MD, "Post-surgical depression can be from the after effects of anesthesia (anesthesia tends to bring out our "sensitive sides" and our anxiety)."
Anticipation and adrenaline are over. Dr. Mary Shinn also talks about the "Surgical Let Down Period". Since you've spent a period of your life managing pain and thinking about life after surgery, now that it's over, you can feel a but lost. In immediate recovery, your life won't have drastically improved yet, so you're in a limbo period.
Pain and discomfort. Pain affects your body and mind. Being uncomfortable and in pain makes it tough to stay positive and avoid falling into a rut.
Narcotic pain medications. Although usually necessary for managing pain, narcotic pain medication comes with a laundry list of side effects. These side effects include: lack of sleep, mood alteration, depression etc. Ask your doctor about your specific pain medication and if you have a history of depression before determining your dose and medication type. Read about narcotic pain medication after surgery.
Lack of sleep. After surgery, getting a good sleep may feel as unlikely as riding a unicorn. Trouble falling asleep and staying asleep affects your mood and mental health. Check out these tips on sleeping after joint surgery (they're applicable to back surgery too!)!
Feeling dependent/ "cabin fever". Not being able to do things independently and feeling stuck in the house can make anyone feel "down in the dumps". Relying on caregivers and not being able to do things as you'd like is tough. This can make you feel lonely and isolated.
A history of depression and anxiety. If you had pre-surgery anxiety or have a history or anxiety, depression, or other mental illnesses, you are at a higher risk of postoperative depression. Surgery can trigger anxiety, stress and depression.
Note: If you're reading this article in response to a loved one who's had surgery, he/she may not recognize their own depression. Major depression can be life-threatening. Talk to a professional about getting help for them.
How to Overcome Post-Op Depression
Although things are changing quickly, there is still some stigma surrounding depression. Some people (especially older generations)may feel too ashamed or afraid to admit that they're struggling. However, reaching out for help and taking advantage of the many tools available to feel better is the single best thing one can do. After all, just about everyone you know has at one point experienced depression (whether it be temporary/situational or chronic).
Almost anyone you talk to about feelings of depression will be able to relate to you in some capacity. If they say they don't relate, well, move on to a more truthful friend/ family member.
Tips on Overcoming Depression After Spine Surgery:
1. Acceptance: Your Situation is Temporary: Feeling depressed after surgery is a real thing. It's also something that usually goes away as you get back to doing what you enjoy, experience less pain, wean off of medication, get more proactive, and so forth. Ongoing depression is also something that can be treated with professional help (including medication, therapy etc.).
2. Reach Out to Friends/ Family: Your inner circle and medical care team are here to help you. Opening up and being honest that you're having a tough time makes those around you want to rally on your behalf. Don't be ashamed to admit you need some help. Your loved ones want to help you.
3. Getting Better Sleep: It's easier said than done but sleep has a huge impact on your mental health. Little things like taking your prescribed pain medication on time, making your bedroom electronic-free, avoiding caffeine etc., can positively impact your ability to fall asleep and stay asleep.
4. Exercise: When you're feeling depressed and recovering from surgery, exercise may feel like the last thing you want to do. However, following your physician and physical therapists recommended ReHab routine, walking, and at-home exercises are key. "Motion is lotion" for your physical body and works magic for your mental health as well.
5. Use PeerWell PreHab/ ReHab for Guidance: PeerWell offers a daily PreHab program that gets spine surgery patients ready for surgery. PeerWell also offers an at-home ReHab program that guides patients each day through the first weeks of recovery. The program focusing on the proven ways to boost physical and emotional healing, while guiding you through a safe and speedy recovery. Letting a program guide you through your recovery gives you a doable shortlist of the most important activities and lessons to spend your energy on (even if your energy feels limited).
6. Get Professional Help: If you speak with your primary care doctor, surgeon, or therapist, they will be able to recommend helpful resources or solutions to you. Your physician may switch your pain medication or prescribe something to treat depression---both may effectively combat your depression. Treatments like psychotherapy, acupuncture, and herbal remedies can also be quite effective. Seeking out a therapist, counsellor, or support group (even an online Facebook back surgery support community) can also help steer you out of stormy weather.
Looking for more guidance in your recovery? Haven't had surgery yet and want to be matched with an orthopaedic surgeon near you that offers PeerWell's PreHab & ReHab program for free? Sign-up here (it's free).