Guest guest Posted July 1, 2005 Report Share Posted July 1, 2005 Gastric bypass surgery patients often find it's not a cure for depression Wednesday, June 29, 2005 By Alana Semuels, Pittsburgh Post-Gazette It's an unnerving thing, to live every day so obese that people mutter under their breath when you walk by, and then, over the course of a year, to drop the weight of one person off your body. Imagine the pounds shedding away, the new clothes to buy, the reactions of people you've known for years, the activities now available -- like taking a ride at Kennywood -- that you could never do before. It would be hard not to think that this weight loss could solve everything -- from that elusive promotion at work to a lackluster relationship. It can change the way you look, why wouldn't it change the way you feel? Janet Forton, 42, who five years after gastric bypass surgery is almost half her previous weight, remembers crying tears of joy after she lost the first 12 pounds after the surgery. She remembers her son giving her a hug and wrapping his arms all the way around her body, something he had never been able to do before. So many things in her life were getting better. But she now knows that gastric bypass is not the cure-all that some expect it to be, and as the number of such procedures done increases, doctors are becoming more aware of the need to emphasize this to patients. Morbidly obese patients often have symptoms of depression that surgery can help lessen, but more often than not, patients with clinical depression before surgery will still have it afterwards. " It's not a silver bullet, " Forton, who lives in , said of the surgery's capacity to kill off depression. She was treated for it for 20 years before her operation and remains in therapy today. " There are certainly people who think that it's going to solve everything -- that's not necessarily the case. " Worst-case scenario There's no way to know why the three individuals who ended up in the Allegheny County Coroner's office chose to end their lives. The only thing they all had in common was that they all had undergone gastric bypass, also called bariatric surgery. It seemed to be successful; two patients had lost more than 100 pounds, one more than 70. But over the course of a year between 2004 and 2005, all three decided to end their lives. In the previous two years in Allegheny County, there had been no suicides after bariatric surgery, according to the coroner's office. While likely mere coincidence, the deaths prompted the coroner's office to write a paper to be published this summer in Surgery for Obesity and Related Diseases, the official journal of the American Society for Bariatric Surgery, stating that depressive disorder may persist after successful surgical control of obesity. " The risk of suicide does not go down with body weight, " said Dr. Omalu, a forensic and neuropathologist with the coroner's office. The surgery " does not cure depressive illnesses. " Depression and obesity Candidates for gastric bypass are usually more than 100 pounds over their ideal body weight. This type of obesity can bring a huge burden of psychiatric and psychological problems, said Dr. Friday, chief of clinical psychology at UPMC Shadyside. " Many of these people are sick and tired of being laughed at in the mall, " he said. The best research available suggests a relationship between obesity and symptoms of depression, said Dr. Kalarchian, assistant professor of psychiatry at UPMC's Western Psychiatric Institute and Clinic, who has collaborated with other doctors there to conduct an in-depth assessment of the psychiatric state of over 200 bariatric surgery candidates. She will present the results of the study on Friday at the annual meeting of the American Society for Bariatric Surgery in Orlando, Fla. " We're seeing high rates of depression and other psychiatric disorders, " Kalarchian said, and although she could not release figures in advance of the presentation, she said that people who seek surgery might have a higher rate of depression than individuals in the community. Kalarchian and her colleagues are following the progress of these patients through the surgery and afterwards. Doctors emphasize that being depressed would not prevent a candidate from getting the surgery, but severely depressed individuals would be treated for their mental health problems before having a surgery that can be difficult to adjust to in itself. " Losing weight can be stressful in good and bad ways, " said Kalarchian. In the past five years, insurance companies and hospitals have started mandating that candidates for gastric bypass be screened to make sure they can handle the mental issues related to it. The screenings also try to help candidates understand what they can and can't expect from the surgery. UPMC's weight management program has done these screenings for about 10 years, although they've only been mandatory for five, said Madelyn Fernstrom, associate professor and director of the UPMC Weight Management Center. They're useful in dispelling the notion that surgery is a quick fix, she said. " One thing the surgery will do is allow you to eat less food, " she said. " It's not going to make you exercise, it's not going to make your marriage better. " Still, it's difficult to pinpoint exactly what it is that would make someone react badly to surgery. A previous mental health problem is probably one sign, but some people can develop issues after the surgery just because they miss certain foods that they can't eat anymore, or their old lifestyle. Post-surgery On average, many patients' moods seem to improve after bariatric surgery, at least in the short term. The physical problems that plagued them become less prominent, and patients often have more energy and feel healthier. Many sleep more easily. But a study done at the East Carolina University School of Medicine in the early days of bariatric surgery found that the significant improvements in mental health immediately after the surgery disappeared by the end of two years in most patients. If depression or other mental health problems continue after surgery, patients might experience problems such as binge eating, anorexia, and bulimia. Or, in rare cases, suicide. Doctors emphasize the need for follow-up to prevent this, and to ensure that patients are eating right and exercising enough to stay healthy after surgery. Many hospitals offer support groups for people who have been through gastric bypass, but none can mandate that patients receive counseling or mental health treatment. Janet Forton remembers going through a grieving process after the surgery, for happy though she was to leave her old life behind, it was still a big transition. Still, before the surgery, despite the screening and packets of information she received, Forton had hoped that maybe the depression would go away. She knew it probably wouldn't, but if the surgery changed everything else, why wouldn't it change the feelings that brought her down? Everything seems to be going her way now -- she's not having any trouble losing weight, has a new job, is working on a master's degree, and for the first time since she was 9, she isn't overweight. But even though she feels on top of the world, she knows that the depression is still there, and needs to be treated. " It's a chemical imbalance in my brain, " she said. " Those chemicals didn't change, and I wasn't sure if they would. " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2005 Report Share Posted July 2, 2005 -Good Informative article Robyn! Thanks, Tami B.-- In GastricBypass-LOSERS , " Robyn@G... " <Robyn@G...> wrote: > Gastric bypass surgery patients often find it's not a cure for > depression > Wednesday, June 29, 2005 > > By Alana Semuels, Pittsburgh Post-Gazette > > It's an unnerving thing, to live every day so obese that people > mutter under their breath when you walk by, and then, over the > course of a year, to drop the weight of one person off your body. > > > Imagine the pounds shedding away, the new clothes to buy, the > reactions of people you've known for years, the activities now > available -- like taking a ride at Kennywood -- that you could never > do before. > > It would be hard not to think that this weight loss could solve > everything -- from that elusive promotion at work to a lackluster > relationship. It can change the way you look, why wouldn't it change > the way you feel? > > Janet Forton, 42, who five years after gastric bypass surgery is > almost half her previous weight, remembers crying tears of joy after > she lost the first 12 pounds after the surgery. She remembers her > son giving her a hug and wrapping his arms all the way around her > body, something he had never been able to do before. So many things > in her life were getting better. > > But she now knows that gastric bypass is not the cure-all that some > expect it to be, and as the number of such procedures done > increases, doctors are becoming more aware of the need to emphasize > this to patients. Morbidly obese patients often have symptoms of > depression that surgery can help lessen, but more often than not, > patients with clinical depression before surgery will still have it > afterwards. > > " It's not a silver bullet, " Forton, who lives in , said of the > surgery's capacity to kill off depression. She was treated for it > for 20 years before her operation and remains in therapy > today. " There are certainly people who think that it's going to > solve everything -- that's not necessarily the case. " > > > Worst-case scenario > > > There's no way to know why the three individuals who ended up in the > Allegheny County Coroner's office chose to end their lives. > > The only thing they all had in common was that they all had > undergone gastric bypass, also called bariatric surgery. It seemed > to be successful; two patients had lost more than 100 pounds, one > more than 70. > > But over the course of a year between 2004 and 2005, all three > decided to end their lives. In the previous two years in Allegheny > County, there had been no suicides after bariatric surgery, > according to the coroner's office. > > While likely mere coincidence, the deaths prompted the coroner's > office to write a paper to be published this summer in Surgery for > Obesity and Related Diseases, the official journal of the American > Society for Bariatric Surgery, stating that depressive disorder may > persist after successful surgical control of obesity. > > " The risk of suicide does not go down with body weight, " said Dr. > Omalu, a forensic and neuropathologist with the coroner's > office. The surgery " does not cure depressive illnesses. " > > > Depression and obesity > > > Candidates for gastric bypass are usually more than 100 pounds over > their ideal body weight. This type of obesity can bring a huge > burden of psychiatric and psychological problems, said Dr. > Friday, chief of clinical psychology at UPMC Shadyside. > > " Many of these people are sick and tired of being laughed at in the > mall, " he said. > > The best research available suggests a relationship between obesity > and symptoms of depression, said Dr. Kalarchian, assistant > professor of psychiatry at UPMC's Western Psychiatric Institute and > Clinic, who has collaborated with other doctors there to conduct an > in-depth assessment of the psychiatric state of over 200 bariatric > surgery candidates. > > She will present the results of the study on Friday at the annual > meeting of the American Society for Bariatric Surgery in Orlando, > Fla. > > " We're seeing high rates of depression and other psychiatric > disorders, " Kalarchian said, and although she could not release > figures in advance of the presentation, she said that people who > seek surgery might have a higher rate of depression than individuals > in the community. > > Kalarchian and her colleagues are following the progress of these > patients through the surgery and afterwards. > > Doctors emphasize that being depressed would not prevent a candidate > from getting the surgery, but severely depressed individuals would > be treated for their mental health problems before having a surgery > that can be difficult to adjust to in itself. > > " Losing weight can be stressful in good and bad ways, " said > Kalarchian. > > In the past five years, insurance companies and hospitals have > started mandating that candidates for gastric bypass be screened to > make sure they can handle the mental issues related to it. The > screenings also try to help candidates understand what they can and > can't expect from the surgery. > > UPMC's weight management program has done these screenings for about > 10 years, although they've only been mandatory for five, said > Madelyn Fernstrom, associate professor and director of the UPMC > Weight Management Center. They're useful in dispelling the notion > that surgery is a quick fix, she said. > > " One thing the surgery will do is allow you to eat less food, " she > said. " It's not going to make you exercise, it's not going to make > your marriage better. " > > Still, it's difficult to pinpoint exactly what it is that would make > someone react badly to surgery. A previous mental health problem is > probably one sign, but some people can develop issues after the > surgery just because they miss certain foods that they can't eat > anymore, or their old lifestyle. > > > Post-surgery > > > On average, many patients' moods seem to improve after bariatric > surgery, at least in the short term. The physical problems that > plagued them become less prominent, and patients often have more > energy and feel healthier. Many sleep more easily. > > But a study done at the East Carolina University School of Medicine > in the early days of bariatric surgery found that the significant > improvements in mental health immediately after the surgery > disappeared by the end of two years in most patients. > > If depression or other mental health problems continue after > surgery, patients might experience problems such as binge eating, > anorexia, and bulimia. > > Or, in rare cases, suicide. > > Doctors emphasize the need for follow-up to prevent this, and to > ensure that patients are eating right and exercising enough to stay > healthy after surgery. > > Many hospitals offer support groups for people who have been through > gastric bypass, but none can mandate that patients receive > counseling or mental health treatment. > > Janet Forton remembers going through a grieving process after the > surgery, for happy though she was to leave her old life behind, it > was still a big transition. > > Still, before the surgery, despite the screening and packets of > information she received, Forton had hoped that maybe the depression > would go away. She knew it probably wouldn't, but if the surgery > changed everything else, why wouldn't it change the feelings that > brought her down? > > Everything seems to be going her way now -- she's not having any > trouble losing weight, has a new job, is working on a master's > degree, and for the first time since she was 9, she isn't overweight. > > But even though she feels on top of the world, she knows that the > depression is still there, and needs to be treated. > > " It's a chemical imbalance in my brain, " she said. " Those chemicals > didn't change, and I wasn't sure if they would. " Quote Link to comment Share on other sites More sharing options...
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