Mental Illness and Bariatric Surgery

[OldBroad]

This is the top story on Salon.Com: Becoming Thin Drove me to the Brink

What do you all think?

 

[Munchkin]

Nope! Don't buy it. I think if you were tilted towards mental illness before surgery, that won't change.

Not that there aren't challenges because there are. Almost everyone has a hard time dealing with the leftovers. It's hard to look OK in clothes and know there is a train wreck in your pants. No matter how realistic you try to be, the picture in your head is one of you the last time you weighed X pounds. And that ain't happening!

The person in this article had the RNY. And has dumping issues. That RNY is a mean surgery. My friends who had it all gained back the weight but most still dump. I don't know. It might make me crazy if I felt like I was going to die if I ate a spoonful of mashed potatoes.

I wasn't young when I had surgery and I was just hoping to be a smaller old bag. Mission accomplished. But this woman is only 21. Very young. And I am sure her expectations were much higher than mine just by virtue of her age. She expected and wanted more than I did. If I had had surgery at 21, I would have wanted more too.

I am no more or less mentally challenged than I was preop. All the crazy just lives in a smaller box. And I am one of the few who didn't even have a psych eval. It wasn't required. It didn't worry me at all. I come from a whole family of crazy people. I know and understand crazy and I know that's not me. At least not yet!

 

[DianaCox]

First of all, how does she not know about bariatric post-op support groups, both IRL and online? There is a ton of anecdotal evidence as well as formal studies on the importance of post-op support. Too many people go through the same thing even though there is a plethora of experience of prior patients which is available to them - but they think they are speshul and don't need help. Especially the young ones.

Second of all - duh! They are SURGEONS - most of them like their patients unconscious and once they're done cutting, they're done with you. And they have little incentive to offer follow up services.

Third of all, many of us think that there ought to be strict psych evals AND (especially for the DS) IQ exams for bariatric surgery. But the surgeons don't want to put any barriers between the patients' and their knives (except for putting them on unnecessary horrible pre-op diets designed to make the patient vulnerable and feeling like they have to suffer to "earn" their surgery). Patients are on their own to get psych counseling for dealing with how their relationships (with friends, family, lovers and food) are changing - and they rarely do before they are in dire need.

Fourth - what do YOU think?

 

[newanatomy]

I don't think her new body caused her depression. I don't think depression is caused or helped by weight gain or loss. Depression in my opinion is not caused by an outside influence. She needs to seek treatment but, not necessarily within the bariatric community.

I do think bariatric patients need to understand that losing weight is not going to make all their problems disappear.

 

[Settledownnow]

It is important to differentiate between "mental illness" and food/body "issues". Needing support and help with adjusting to the physical and emotional challenges is be expected, but this is not the same as "mental illness".

What I find more concerning is the high rate of alcohol and drug abuse prior to WLS and after WLS http://news.harvard.edu/gazette/story/2012/07/alcohol-abuse-after-weight-loss-surgery/

 

[Clematis]

the picture in your head is one of you the last time you weighed X pounds

You betcha. This is tough for me. Whenever I envision myself thin, I envision myself 25+ years younger. I'm in for a rude reality check. (But I'll get through it.)

Back to the point: So 93% had been diagnosed with "mental illness"? I find this impossible to believe unless the mental illness is overeating as a food disorder. Seriously, of all the labels pinned on the obese, now were crazy too?

 

[Munchkin]

Maybe there is a lesson to learn here. Just embrace your personal crazy and move on. It's an even bet the individual standing next to you has their crazy too.

So WLS makes us nuts and so does being fat. And bacon gives you cancer.

 

[southernlady]

So WLS makes us nuts and so does being fat. And bacon gives you cancer.

THAT should be our motto!

 

[Charris]

My marriage ended due to weight loss surgery. I had mines first then he had his. We totally had different reasons for being fat. He was obsessed with food. Cried the first day home after surgery because I wouldn't give him some of my food. Once it was all said and done he couldn't handle the fact I was successful and he wasn't. Gave me ultimatum if you loose anymore weight I'm leaving. Don't let me hold you hostage go so I move him out of my house one Friday while he was at work.

I think people who have mental health problems have them before surgeries and after. 73% of people tried to commit suicide? Did I read that correct? I know tons of WLS post-op and none of them that I know have thought about it because of Wls

 

[DSRIGGS]

My marriage ended due to weight loss surgery. I had mines first then he had his. We totally had different reasons for being fat. He was obsessed with food. Cried the first day home after surgery because I wouldn't give him some of my food. Once it was all said and done he couldn't handle the fact I was successful and he wasn't. Gave me ultimatum if you loose anymore weight I'm leaving. Don't let me hold you hostage go so I move him out of my house one Friday while he was at work.

I think people who have mental health problems have them before surgeries and after. 73% of people tried to commit suicide? Did I read that correct? I know tons of WLS post-op and none of them that I know have thought about it because of Wls

No, 73% of the 8,877 people in the study did not try to overdose. 73% of the 158 people who self harmed tried to overdose. 158/8,877 self harmed. I am not sure how that lines up with the general population but I bet it isnt staggeringly different. As the Father of a son who has and is still battling depression I can tell you that depression and self harm is far more prevalent in your local community than you would have imagined. When I mentioned to some people publicly that our son was battling depression I can't tell you just how many people told me that their sin, daughter, father, etc had or was fighting mental issues.

To me this study isn't saying a tremendous amount other than screening for mental illness should be more common place and stringent than it has been for bariatric surgery candidates.

 

[OldBroad]

Fourth - what do YOU think?

OK, I'll bite. I think that morbid obesity and depression in particular have a mutually reinforcing dynamic. Which came first, the depression or the obesity? It doesn't really matter. Fat people in an appearance-obsessed society are likely to become socially isolated and depressed. People with depression, living in a toxic food environment and suffering from a lack of physical and emotional energy, can easily become obese. Addressing the obesity with surgery, but without dealing with the depression that is tied up in the obesity, creates a risk of decompensation. The frequency of addiction substitution in bariatric surgery patients is evidence of that.

That fact that the author had the RNY, has dumping problems, was young and had unrealistic expectations for her appearance, certainly added to the distress that she experienced. Nevertheless, her main point was worth making: having bariatric surgery can exacerbate pre-existing mental health issues if they are not properly addressed before and after the procedure.

 

[duh_Mom]

Interesting article. This person sure was not ready to have any kind of surgery, much less something as life changing as RNY. I think she needed to do a lot of emotional work before she ever had the surgery.

 

[Elizabeth N.]

You betcha. This is tough for me. Whenever I envision myself thin, I envision myself 25+ years younger. I'm in for a rude reality check. (But I'll get through it.)

Back to the point: So 93% had been diagnosed with "mental illness"? I find this impossible to believe unless the mental illness is overeating as a food disorder. Seriously, of all the labels pinned on the obese, now were crazy too?

In the studies I reviewed in preparation for my undergrad honors thesis, the most commonly occurring psych diagnoses in persons seeking WLS were anxiety-related, followed by depressive disorders. Eating disorders tended to come in third place. Sometimes the order was reversed, but not often. I reviewed a good four dozen articles, but a lot of those were not study reports. IIRC there were about a dozen studies in that pile of reading.

 

[Txkat]

I am very lucky that my bariatric study includes monthly visits with their psychologist, who is one of the most published researchers in the country on weight loss and bariatric related mental health issues. Here's the skinny. Your gut produces seratonin, and it produces it from carbs. Carbs literally can make you feel better mentally. In the immediate post surgery period, you're consuming virtually no carbs, and your gut has been altered. People with a tendency toward anxiety and depressive mood disorder could very well have some issues. Just like everything else, your body need time to adjust to your new gut chemistry. Nobody knows exactly how or where in the digestive tract psych meds enter the bloodstream, so for a fair number of bariatric patients, some trial and error with SSRI type medications is completely normal. At 1 year after surgery, about 40% of successful bariatric patients are on some type of psych med. it's just another possible complication that a good doctor/ medical team should prepare you for.