The person who evaluated you felt that you might have a clinical diagnosis of depression. She referred you for treatment, and you wonder if the diagnosis will prevent you from having surgery.
It would be very unusual for a new diagnosis of depression to prevent you from having weight loss surgery.
One of the purposes of the preoperative psychological evaluation is to screen for depression. Depression and anxiety are very common in people who are seeking surgery. Patients who have depression will have a much easier time dealing with changes after surgery if they are on appropriate treatment with a combination of medication and psychotherapy. Treatment may also improve weight loss over the long run.
It may take up to two months to see changes following the start of medication for depression. So your therapist may want to see you for follow up several times before giving the final OK for surgery. It is also very important for you to make a commitment to see the therapist on a regular basis after surgery to monitor your medications and to talk over challenges that you face.
Here are some abstracts of articles from the medical literature to add perspective. Finally I've included a link to an article on our ASMBS web site that explains the psychological evaluation. You can do further research on the National Medical Library search site, PUBMED.
1. Obes Surg. 2008 Oct 29.
Psychological Characteristics of Morbidly Obese Candidates for Bariatric Surgery.
Abilés V, Rodríguez-Ruiz S, Abilés J, Mellado C, García A, Pérez de la Cruz A, Fernández-Santaella MC.
Department of Clinical Nutrition and Dietetics, Virgen de las Nieves University Hospital, Avda. Fuerzas Armadas No. 2, 18014, Granada, Spain,
veronica.andrea.exts@juntadeandalucia.es.
BACKGROUND: Morbid obesity has multiple negative consequences for psychological health. These patients are described as depressed, anxious, and impulsive, with low self-esteem and impaired quality of life. The severity of these psychological disorders has been related to the degree of obesity. The aim of this study was to analyze the psychopathological characteristics of obese candidates for bariatric surgery, determining differences and similarities in general and specific psychopathologic symptoms among patients with different degrees of obesity and normal-weight individuals. METHODS: The study included 50 patients (26 type III obesity, 24 type IV obesity) and 25 normal-weight volunteers. They were all assessed for: stress (CED44-B), anxiety-depression (General Health Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), family function (Apgar Family Function Questionnaire), quality of life (Spanish version of the Quality of Life Index), personality (Eysenck Personality Questionnaire-Revised), food craving (Food Craving Questionnaire-Trait), and eating behavior disorder (EBD) symptomatology (Eating Disorders Examination-Questionnaire Version-4). RESULTS: The obese patients had higher levels of stress, anxiety, depression, food craving, and EBD symptoms and lower levels of self-esteem and quality of life compared with normal-weight controls. No personality or family function disorders were observed in any of the obese or normal-weight subjects. Patients with type III and type IV obesity differed only in anxiety and personality findings. CONCLUSIONS: Although the presence of psychological disorders cannot be taken as an absolute criterion for exclusion of candidates for obesity surgery, a better understanding of the relationship of these variables with weight loss and other outcomes of bariatric surgery may improve patient selection and facilitate more appropriate interventions.
2. Dig Dis. 2008;26(1):36-9.
Psychological profile of obese patients.
Lykouras L.
Athens University Medical School, 2nd Department of Psychiatry, Attikon General Hospital, Athens, Greece.
elykoura@med.uoa.gr
Nowadays obesity is recognized to be one of the greatest public health problems worldwide. There is no indication that the huge increase in obesity seen the last decades is declining. The examination of psychological aspects of persons with morbid obesity is essential. Identification of the psychological factors associated with weight loss expands our knowledge about behaviors which are crucial in order to avoid failures in treatment. Most information on this is obtained preoperatively. Although there is no single personality type characteristic of the morbidly obese, they differ from the general population as their self-esteem and impulse control is lower. They have passive dependent and passive aggressive personality traits, as well as a trend for somatization and problem denial. Their thinking is usually dichotomous and catastrophic. Obese patients also show low cooperativeness and fail to see the self as autonomous and integrated. In the morbidly obese before undergoing surgical treatment, unusual prevalence of psychopathology, namely depression and anxiety disorders, is observed. They are subject to prejudice and discrimination and should be treated with concern to help alleviate their feelings of rejection and guilt. Information on the psychological profile of obese persons is limited. Future studies are warranted, since there is a pressured need for these people to built cognitive skills and control their body weight. Copyright 2008 S. Karger AG, Basel.
3. Surg Clin North Am. 2001 Oct;81(5):1001-24.
Psychosocial aspects of obesity and obesity surgery.
Wadden TA, Sarwer DB, Womble LG, Foster GD, McGuckin BG, Schimmel A.
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA.
wadden@mail.med.upenn.edu
There is a growing consensus that bariatric surgery is the treatment of choice for extremely obese individuals who have failed to reduce their weight satisfactorily using behavioral or pharmacologic interventions. The gastric bypass in particular is associated with excellent long-term weight loss. Although most extremely obese individuals will have essentially normal psychological functioning, a significant minority suffer from depression, binge eating, trauma, or other emotional complications that may require treatment before or after bariatric surgery. A structured behavioral assessment, conducted by a mental-health professional and a registered dietitian, can readily identify those who are most likely to require adjunct counseling.
Suggestions for the pre-surgical psychological assessment of bariatric surgery candidates. From ASMBS
http://www.asbs.org/html/pdf/PsychPr...Assessment.pdf
psychological evaluation
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