The Alarming Link Between Depression and Bariatric Surgery

Dr. Christopher McGowan
May 21, 2021

If you have been struggling to lose weight, you might imagine the dramatic weight loss promised by traditional bariatric surgery would bring about a new, happy chapter in life free from your former challenges. Many people who pursue bariatric surgery do lose tremendous amounts of excess body weight, but there is sometimes more to the story.

The truth is, many people who choose to permanently reduce the size of their stomachs through a Roux-en-y gastric bypass or similar procedure find that instead of effortless living, insomnia and even depression are waiting down the road. 

What is the Connection Between Weight Loss Surgery and Depression

If you have done your homework on weight loss surgery, you know that as many as one in five people who have had a gastric bypass later regain the weight they lost after surgery. What you may not know is that a number of people who choose bariatric surgery to lose weight also struggle with depression after surgery. 

The links between depression and surgery for obesity are complex, and are often rooted in mental health issues that may have contributed to someone’s obesity in the first place. Mood disorders are not always on the list of comorbidities listed for individuals with a high body mass index (BMI), but it turns out significant weight gain is a relatively strong predictor for many different kinds of mental health issues. Studies have shown higher prevalence of mental disorders in severely obese patients, and while physical conditions like hypertension and diabetes tend to get more attention as consequences of being overweight, depression and other psychological issues are often part of the mix as well.  

Obesity-related psychological issues such as binge eating may seem like obvious links between the field of psychiatry and nutritional concerns. Clearly diagnosed eating disorders are not the only connections, though. Impulse control, addictions, unresolved traumas, anxieties, and more all have connections to increased chances of being significantly overweight. While the pounds may melt off after a weight loss surgery, these pre-existing psychological challenges don’t simply disappear after surgery. 

It is not uncommon for bariatric surgery patients to report depressive symptoms appearing or getting worse post-surgery. The dramatic changes in diet and lifestyle that are demanded after gastric bypass surgery can take a toll on your mental health. Everything from your social habits to your brain chemistry changes after surgery, and navigating these changes can be difficult. 

Does Gastric Bypass Change Your Personality?

Gastric bypass surgery, or even the less drastic minimally invasive weight loss procedures available, can cause dramatic changes to your body, but they don’t change your personality outright. This does not mean, however, that you might not struggle with depression, anxiety, or acting out from the stress you are feeling as your body changes. 

Treating severe obesity through a gastric banding, sleeve gastrectomy, or gastric bypass procedure will bring about more than just a reduction in body weight. Hormone levels such as leptin and ghrelin will go through several phases in the first few years after surgery. Lowered levels of serotonin may also be likely as you remove carbohydrates from your new restricted diet. There may even be some issues such as temporarily lowered levels of vitamin D as you and your doctor work to get the right mix of nutritional supplements that your new digestive tract will accommodate. 

Does Weight Loss Surgery Help Depression?

Whether or not weight loss surgery helps depression is dependent on many factors, including what was contributing to your depressive symptoms in the first place. Some gastric bypass patients report that the improved body image, self-acceptance, better sleep, and other health benefits of significant weight loss alleviate some sources of depression. Others are not so lucky, finding the loss of access to favorite food and drink, or persistent insomnia that can follow weight loss surgery, makes their depression worse. 

Depressive symptoms and insomnia are both common at different periods during the first few post-surgery years after a gastric bypass. These can be caused by no longer having access to food as a coping mechanism, or even from your brain being deprived of serotonin generated by the insulin spike that follows a carb binge. 

Tryptophan, Carbs, Serotonin, and Depression 

Saying carbs and sugary treats are comfort food is more than just a turn of phrase. Increases in insulin that result from eating large amounts of carbohydrates stimulate the brain to produce tryptophan, an amino acid that is essential for the production of serotonin, a neurotransmitter associated with elevated mood. Many antidepressant medications are designed to help increase your serotonin levels, so it should be no surprise that studies have linked changes in mood to the amount of carbs you are allowed to eat. 

If serotonin from carbohydrate intake has been a source of comfort in the past, it is important to consider the lack of that customary carb kick a weight loss surgery diet demands. With so little room in the stomach for food, calories need to be counted very carefully, proteins will take precedence, and carbohydrates will be in scarce supply.

It is important to consider that women have lower baseline levels of serotonin in their brains than men, and are therefore potentially more prone to depression. This is added to the societal pressures around body image and weight gain, which can contribute to a range of eating and depressive disorders more common in women. 

Understanding the Causes and Severity of Depression

To properly understand the links between depression and weight loss surgery, you need to delve deeper into the types of depression and what can cause different depressive symptoms. For some people, short-term, relatively mild depressive symptoms can occur as they deal with specific physical and emotional challenges that follow a gastric bypass. For others, more severe and chronic depression can be worsened or even caused by the metabolic and lifestyle changes they are working through after surgery.

The post-surgery challenges people report include the inability to join in on a Thanksgiving feast or even dine out with friends in ways they were previously used to. Eating behaviors are part of a larger psychosocial context that many people overlook. When the pre-surgery social rituals of eating during holidays or even a simple night out with friends someone may have enjoyed are no longer available, people may feel a sensation of separation or isolation, which can lead to an increase in depressive symptoms over previous levels. 

Sleep Issues and Bariatric Surgery

One of the more serious and tangible concerns for people who undergo bariatric surgery is an inability to sleep. While obesity is linked to sleep problems, it turns out that weight loss surgery can lead to troubles sleeping as well. More worrying, developing insomnia postoperatively can put you at risk of a form of insomnia that is highly resistant to treatment. Given that lack of sleep is highly correlated to a range of mood disorders and depressive symptoms, this potential risk should be taken very seriously.

How to Identify Depression

Depression is not always easy to identify. Many people are unaware that they or others in their circle are depressed. This can lead to undue suffering, and potentially even leave suffering people at risk of self-harm or suicide. Some of the signs of post-surgery depression can include:

  • lowered mood
  • diminished interest or pleasure in activities 
  • Insomnia or hypersonmia (excessive daytime sleepiness)
  • fatigue or loss of energy 
  • feelings of excessive guilt or worthlessness
  • lowered concentration and indecisiveness
  • thoughts of death or suicide
  • significant changes in appetite 
  • irritability or increased physical discomfort without evident reason

Best Practices for Weight Loss Surgery

Preparing well for any kind of surgery for weight loss means preparing well. This means working hard to acclimate to the changes to diet and lifestyle habits surgery will demand before it is time to go under the knife. Not only does this mean changing your diet to lose as much weight as you can before surgery, but it means beginning the process of finding support groups or other sources of help to make your weight loss journey a success. 

Getting help along the way is not just about making it easier to avoid some sneaky snacking after surgery. Your health, or even your life, could depend on it. Self-harm and suicide have much higher prevalence among bariatric surgery patients than in the general population.

The journey of any weight loss procedure or gastric bypass is a long one, lasting from careful consideration and preoperative planning to follow-up long after surgery is over. Ensuring an enduring quality of life after surgery demands treating the whole person, which means considering whether someone is a good candidate for surgery. Morbid obesity is only one consideration, with the increased risk of psychiatric disorders being a serious matter for doctors and prospective patients to discuss. 

The potentially serious mental health consequences of weight loss surgery is one more reason to look at all the options available to you if you are considering a gastric bypass. Recent years have seen the development of other, minimally invasive procedures to traditional gastric bypass that can produce nearly the same results, while not introducing the same risks associated with permanent changes to the digestive system.

Whether mental health concerns or other considerations for your physical well-being are giving you pause as you consider weight loss surgery, getting the full picture of the options, risks, and rewards you may be facing is essential. Request a consultation today at True You Weight Loss to learn more about the choices and opportunities ahead of you as you work to find freedom from excess body weight.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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