Bipolar Disorder & Bariatric Surgery
Bariatric Surgery’s Emotional Risks for Women
Psychological repercussions from a weight-reduction operation can include self-harm emergencies.
By Tammy Worth
Medically Reviewed by Bhargavi Patham, MD, PhD
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Surgeon Jenny Choi, MD, had a patient who was so ashamed of her extreme weight gain that she had almost completely stopped leaving home. After undergoing bariatric surgery, the woman lost nearly 150 pounds and happily regained her social life.
She’s just one example of the majority of the patients Dr. Choi has treated as at the Montefiore Medical Center in New York City who become healthier and happier after weight-loss surgery.
But a small portion of bariatric surgery patients have a different experience. Their lives may not change as they expected, their weight may return over time, or they may be uncomfortable with a new and different body. Although bariatric surgery is meant to change a person’s physical shape, a whole host of psychological repercussions can come from dealing with obesity and the aftermath of a weight-reduction operation.
“I’ve seen it really transform people’s lives again and again,” says Louis Aronne, MD, director of the Center for Weight Management and Metabolic Clinical Research at Weill Cornell Medicine in New York City. “But weight loss of any type can have an effect on mood … the effect is complex, to say the least.”
Pre-Existing Struggles With Mood Disorders and Obesity
An October 2015 study inJAMASurgerylooked at more than 8,000 Canadian adults before and after bariatric surgery. Researchers found that a small group, 111 patients, experienced self-harm emergencies after the procedure. The numbers showed a significant increase in such instances — about 1.5 fold after surgery — in this group of patients when compared to the years before treatment. A majority of the incidents were intentional medication overdoses.
Most of the patients who harmed themselves had been diagnosed with a mental health condition prior to the surgery. It makes sense that someone already struggling with anxiety, depression, or bipolar disorder might be more likely to have a mental health condition after surgery.
Choi says she sees patients who have dealt with sexual assault, psychological trauma, and unstable childhoods. Many come to her feeling shame, embarrassment, and depression after years of unsuccessful yo-yo dieting.
A 2014 analysis of studies on bariatric surgery patients inCurrent Opinion in Psychiatryfound that about 40 percent had been diagnosed with at least one psychiatric disorder.
“More often than not, patients cry at their initial visit with me,” Choi says. “They can’t believe they let themselves get to that point.”
Rebounding After Bariatric Surgery
The self-harm experiences of the patients in theJAMAstudy typically occurred in the second and third year after surgery. If you aren’t following post-surgical diet and exercise regimens, this is the time you’re most likely to regain weight, which can make you depressed or anxious.
During the first 18 to 24 months after surgery, gut hormones like ghrelin and peptides that regulate hunger are low, making it somewhat easy to eat smaller portions and stick to your treatment plan, Choi says. After that, other mechanisms in the body kick in and your appetite is again stimulated.
Daniel Stettner, PhD, director of psychology at Unasource Comprehensive Weight Loss Center in Troy, Michigan, points to psychological issues that are inherent in most people, but tend to kick in after bariatric surgery and sabotage weight loss. One is complacency — you become comfortable with your weight loss and quit working at it. Over time, weight can slowly return. Post-surgical patients may also play mind games, saying to themselves, “A little bit of chocolate won’t hurt me” or “Let’s see what I can get away with and still stay slim.”
Dr. Stettner says most patients’ depression is associated with unrealistic expectations — the hope that bariatric surgery will make all of their problems go away.
“Anyone going for the surgery needs to have reasonable expectations of what’s going to happen,” Dr. Aronne agrees. “Are they going to lose weight and be healthier? Yes. Are they going to get down to their ideal body weight, look terrific, and get married? Nobody knows the answer to that.”
Physical Changes After Bariatric Surgery
Some emotional changes people experience after weight-loss procedures may be caused by physical changes in their bodies.
One issue is a loss of adrenaline production. According to Aronne, in some cases, the adrenal system gets toned down when you lose weight. Having a less intense adrenal system can make you feel lethargic, tired, and depressed, he says.
Another challenge is insomnia. According to a 2012 article inObesity Research and Clinical Practice, one-quarter of 2,300 patients who had bariatric surgery reported insomnia afterward. And those with insomnia were more likely to have had a history of mental health issues, and reported poorer health outcomes, than patients who didn’t have insomnia.
If you have bariatric surgery, you may also be at risk for vitamin deficiencies, which can lead to depression. After surgery, food is absorbed into the intestines differently than before, and, Choi says, patients are particularly at risk for low levels of vitamin D.
Not only is food absorbed less efficiently, but post-surgery patients also have to deal with extreme dietary restrictions. For the first year, recommended intake is less than 1,000 calories per day, from a diet high in protein and very low in carbohydrates. This can cause a couple of interrelated problems for some people.
RELATED: 5 Ways to Avoid Weight Gain After Bariatric Surgery
People who had a carbohydrate addiction prior to surgery sometimes look to alcohol, also a carbohydrate, to satisfy this need. Stettner says having a family history of alcoholism can make you particularly susceptible to this problem after surgery.
Stettner notes that carbohydrates “impact the pleasure centers of the brain, and it’s a self-medicating phenomenon. It probably involves both serotonin and dopamine.” And lower levels of these hormones can contribute to depression.
Choi has had a couple of patients who suffered from alcohol addiction after surgery. Some simply replaced overconsumption of food with excessive intake of alcohol. After gastric bypass surgery, you can become intoxicated more quickly and have no hangover, which makes it even easier to overindulge.
Obesity is a complex issue, not just caused by a person’s DNA or inability to resist Twinkies. A mind-body connection contributes to the condition — and to your potential for success or failure after bariatric surgery.
“Most of the work is in the mind, and surgery is secondary,” says Stettner.
Video: NewStart Bariatric Surgery from Memorial Hermann
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