So those who've read my posts know that I asked a lot of questions before surgery about post-op depression, and have had a few struggles since my surgery with the problem. I've had a lifelong history with depression and anxiety, and have at various points in my life done therapy and been on just about every medication known. None of those things worked, long term.

Note: some people do suffer real physiological depression post-op. It is well documented, and you should always talk to your doctor if you're struggling. I'm just posting my findings so that some of you might have a head start in unraveling this ball of twine.

What I'm finding is that my depression is almost entirely related to physiological factors. In short, when I take care of my physical needs adequately, I'm not depressed or anxious. In fact, when I'm getting enough sleep, food (especially carbs -- yes, the evil carbs!), Water, and exercise, my mood is very, very good. When I AM taking care of myself, I'm calm (not anxious), hopeful, and generally a pleasant person.

However, any of the following will QUICKLY put me into a tail spin:

1. Not getting enough sleep. I don't know how many times I'm going to have to re-learn this lesson, but for posterity, here it is: if I don't get enough quality sleep, I'm a wreck. This is getting more pronounced as I get older, and has gotten dramatically more pronounced since the surgery. It used to be that it took a week or two of crappy sleep (or not enough sleep) to bring me down. Now a day or two and I'm a wreck.
   
2. Not getting enough exercise. This is intimately tied in to sleep; when I am exercising regularly and vigorously, I sleep better. But even if you take sleep out of the picture, exercise has worked better for me than any antidepressant I've tried, and it has worked quicker. Don't get me wrong, I'm a big fan of better living through chemistry; if you need AD's, take them, but for me, exercise is much more effective. It can nip an anxiety attack in the bud, and 15 minutes of brisk walking in the sunshine (or even in the gray... come on, this is Seattle!) can prevent an entire day of blue moping.
   
3. Not eating enough. If I don't eat enough food, or good enough food, I am a mess. I get wobbly and cranky and prone to irritability and depression. Worse, I tend to compensate-eat later, and eat far more calories (and far worse calories) than I would have if I'd just forced myself to eat properly to begin with. Also, I've noticed a strong correlation between mood and carbohydrate intake in particular. I guess it makes sense; taking in far fewer calories means I have far fewer reserves to spare, but quite often snapping out a blue funk is as easy as drinking a glass of skim milk (which has both Protein and milk sugar -- a win/win combination of carbs and protein, according to my nutritionist).
   
4. Not drinking enough. This doesn't make me blue, but it makes me feel ill and grumpy, and that often leads to OTHER bad behaviors that precipitate blue-ness.
   
5. Drinking too much caffeine. Of course, overindulgence in caffeine is always a shortcut to feeling icky, but since my surgery I've found that my tolerance is much, much lower. One big cup of coffee can make we wired and jittery for hours, followed by a deep crash of exhaustion and depression and anxiety. It's almost not worth it anymore.
   
6. Drinking too much alcohol. Similarly, alcohol is a depressant so this shouldn't be that surprising. What's surprising is how much stronger the effects are now. Particularly, unfortunately, the negative effects -- two or three drinks and I'm hung over, moody and anxious the next day. Just like caffeine, it's to the point where the "fun" is almost not worth the cost.
   

None of this means that I can avoid other good mental hygiene, like keeping social contacts strong and so forth. But ultimately, I find that simply taking care of my body -- doing the things I should be doing anyway -- is the most potent antidepressant available. It's as simple as this: when I take care of myself, I don't get anxious or blue. When I don't, I suffer.

So, nobody should take my posting as a recommendation to avoid meds. I am not anti-meds -- not at all. Better living through chemistry, baby (I mean, come on, I paid 20 grand out of pocket to have my stomach sliced up instead of "just" dieting and exercising; would someone who is anti-medicine do that?) I thought I was really clear about that, but I'll say it again: you really need to talk to your doctor about depression, and if you need meds take them.

That being said, the point of my post was that, for me, taking meds has never been as effective as remembering to take care of my physical needs. I don't know how many people are like me, but I don't always "remember" to take care of myself, but I always, always always pay the price. So I have to consciously remember to get enough sleep, eat enough healthy food, drink enough Water, etc. And one of the prices I pay if I don't do those things is depression and/or anxiety.

I suspect that for a lot of us, depression worsens after surgery. Not because of fear of mortality or anything deep and psychological like that, but simply because our brains are part of our bodies, and if we're not taking care of our bodies, we're not taking care of our brains! It's amazing how many people forget that they are a "part of" their physical selves and think that they can neglect their basic health and still keep firing on all cylinders, mentally and emotionally. I don't know about you guys, but I just don't work that way -- especially since the surgery.

So, if you need meds, TAKE THEM. But also, try to take better care of yourself -- do all the things you know you're "supposed to" be doing -- and see if that doesn't help at least a little.

Oh wow....I could have written your posts word for word....I have suffered mild depression and anxiety, and I too find that lack of sleep send me into an out of control spiral. I have been on lexapro for a little over a year, and right before surgery my PCP upped my dosage as a preventive for what he though would be me grieving food. Surgery has had a very positive result in my behavior, I am more in tune with my body and it's needs. yes I do eat carbs, I eat everything. I was laughing because looking at my graphs on myplate.com, my caloric intake has never been more balanced. I am also getting to sleep without drugs for a change....and I am feeling pretty up beat. My lexapro will be dropped to my previous level next month and my dr.'s hopes are that I will be off by next spring.....however it will always be something I have to be mindful of. In my experience it has always been easier to deal with others and others' needs rather than focus on me. It is amazing what happens when I turn attention to myself.... Thanks for posting.....