I never considered bariatric surgery until my gyn suggested it. Having spent countless hours researching it and interviewing several surgeons along with my husband, I’ve decided to go ahead with it. I’m elated to think I can jump start my way to a new life. I don’t see this as an end in itself or as a cure-all, but rather as a powerful tool. Don’t see it as giving, see it as taking charge.

So what’s the problem? My psychiatrist objects. She hasn’t articulated anything beyond saying this is a drastic step and we should explore other alternatives...like appetite suppressants. I’m clinicaly obese. Appetite suppressants aren’t turning this ship around.

Shes a fantastic doctor and I know she cares and wants to do well by her patients. She helped get me out of a BP depression several years back. I’m fully recovered and I’m religious about my meds.

So i’m in the uncomfortable position of having to persuade my shrink not to stand in my way.

Just venting.

That's a tough place to be in, especially since you value her, because you'll need to fully engage in discussion and get your point across even if it's unpleasant for you, her, or both of you. What else can you do? This means a lot to you and you deserve to have an effective tool to battle obesity. I wish success. Don't lose hope.

I would suggest a frank conversation with her to find out why she objects. Are there risks for your mental health that she sees? Does she anticipate an issue with your BP depression? It could just be that she personally thinks its drastic, unsafe or has other ideas about it, which is fine, but that’s not her area of expertise. She obviously can’t stop you, but you really want to understand why she thinks its a bad idea.

2 minutes ago, Losebig said:

I would suggest a frank conversation with her to find out why she objects. Are there risks for your mental health that she sees? Does she anticipate an issue with your BP depression? It could just be that she personally thinks its drastic, unsafe or has other ideas about it, which is fine, but that’s not her area of expertise. She obviously can’t stop you, but you really want to understand why she thinks its a bad idea.

2 minutes ago, Losebig said:

I would suggest a frank conversation with her to find out why she objects. Are there risks for your mental health that she sees? Does she anticipate an issue with your BP depression? It could just be that she personally thinks its drastic, unsafe or has other ideas about it, which is fine, but that’s not her area of expertise. She obviously can’t stop you, but you really want to understand why she thinks its a bad idea.

Hi Losebig.

So far, all she has said is that it is a drastic step and that we should do further “work-ups” first. She hasn’t said anything about the BP component. I’ve chosen a surgeon experienced in this area and I’ve read everything I have been able to find on the topic. If there was a risk this would jeoradize my mental health, I wouldn’t do it.

I have an appt scheduled with her for later in the month once I have the sleep study and liver scan results back.

Will the surgeon ordered psych exam require that my private psychiatrist weigh in? I assumed so.

It's important to remember that just because someone is in a medical profession it doesn't mean that they have been educated about bariatic surgery. Some still see it as a last-resort or as 'copping out'. My PCP is totally stoked about my choice to pursue gastric bypass but two family members in medical professions (nurse and general practitioner irrespective) have been distinctly unsupportive. Ultimately I choose to side with those who have all the information available. Good luck!

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You don't say what other alternative weight loss methods you've tried before and what kind of success you've had, if any. Part of the psychiatric evaluation is to ensure you have the proper mindset to be able to handle the drastic lifestyle change that WLS will require. Perhaps she has concerns in that area?

Also, note that you don't have to have approval from your psychiatrist, but rather any psychiatrist, preferably one who does know about WLS and its requirements. Most people don't see psychiatrists regularly, so my bariatric surgeon referred me to a psychiatrist who specializes in this type of evaluation. Your surgeon should be able to do the same.

I’m in the pre surgery process and have been approved for surgery on February 19th. I had a major depressive episode years ago after my divorce. I haven’t needed to take antidepressants in over five years. The psychiatrist that I am consulting with talked to me quite a bit about the the incidence of post bariatric surgery depression and that there is a significant chance that I might need to start taking medication again. He feels that I need to be watched closely for problems. I remember him making the statement that they really didn’t know why, but bariatric patients have an increased incidence of post-operative depression. I have not researched the statistical data to validates his statement, it might be worth the time to read up on the issue.

Hi. Thanks. Yes, I’ve seen that a few times. I’m asking the psych who I’m being referred to about it. I’m already taking anti-depressants, so that would theoretically protect me.

1 hour ago, elforman said:

You don't say what other alternative weight loss methods you've tried before and what kind of success you've had, if any. Part of the psychiatric evaluation is to ensure you have the proper mindset to be able to handle the drastic lifestyle change that WLS will require. Perhaps she has concerns in that area?

Also, note that you don't have to have approval from your psychiatrist, but rather any psychiatrist, preferably one who does know about WLS and its requirements. Most people don't see psychiatrists regularly, so my bariatric surgeon referred me to a psychiatrist who specializes in this type of evaluation. Your surgeon should be able to do the same.

What kinds of lifestyle changes did it mean for you?

As for me, I’ve been on WW on and off most of my adult life. I lose, I gain more, etc. Atkins. SouthBeach. I exercised a lot for a while, but fell of the wagon when I had children.

1 minute ago, ElseeG said:

What kinds of lifestyle changes did it mean for you?

As for me, I’ve been on WW on and off most of my adult life. I lose, I gain more, etc. Atkins. SouthBeach. I exercised a lot for a while, but fell of the wagon when I had children.

Actually, I'm just a week and a half into my three month pre-op diet and haven't had the psych evaluation yet. I was just posing potential issues your psychiatrist may have about you since you did not give a lot of information about your previous attempts at weight loss.

I didn't even know there was a psych requirement until a month ago and my surgeon explained it was to ensure that the patient has the proper mental outlook to handle the lifestyle changes the surgery will require. Someone deemed too depressed might not pass the evaluation out of fear that he/she won't make the proper effort to follow the post-op diet. The same thing could apply to someone who has a history of making empty promises.

I wouldn't worry about being declined due to having had problems sticking to a diet though, since that's a common element among everyone seeking WLS.

I had bariatric surgery 5 years ago. One of the initial steps was to get approval from a psychiatrist. The psychiatrist was on staff at the hospital that specializes in bariatric surgery. The psychiatric exam took about an hour. The main focus was determining if I had any underlying problems that might prevent the surgery from being successful. They asked a number of questions, many dealt with how I became overweight. I just answered them truthfully and that step was done.

James,

Congrats on hitting the five year mark! What have been some of the greatest challenges post-op? What has been most difficult?

Thanks.

3 hours ago, ElseeG said:

Will the surgeon ordered psych exam require that my private psychiatrist weigh in? I assumed so.

I had to see a psychiatrist as part of my six month work up for insurance. The surgeon recommended the psychiatrist. I'm certain that you can go to someone else for your bariaric psyche evaluation. If your paying out of pocket you may not have to see the psychiatrist.

So it's vitally important when you're on any drug therapy for psych stuff, especially BP, to work with your bariatric surgeon and your psych to make a plan for post WLS. With your new anatomy, you may need changes to your meds. And it's super important to know what those changes are going to be up front, before the surgery happens, that way you can help avoid a crash after surgery. Cuz it's gonna be hard enough emotionally to handle the effects of the surgery itself, let alone, having a crash with your meds too. Right?

So if it were me, I'd really be frank with your present psych. Get him/her on board. After surgery, we have to gets subs for extended release meds and also enteric coated meds. Our new anatomies don't give us the time or stomach acid to dissolve pills that have an enteric coating on them, so they end up not being absorbed. Again, because things go through our system so much quicker, extended release pills don't work well for us, because they are malabsorbed.

Congrats on really staying on top of your BP meds so your BP remains stable. That's no small undertaking and you deserve to be congratulated!!! I've seen many people with BP who've done perfectly well with RNY and VSG. I just fall into the group that things it is better to plan for success rather than rally through a crisis. ((hugs)) You'll figure it out!

11 hours ago, ElseeG said:

Hi Losebig.

So far, all she has said is that it is a drastic step and that we should do further “work-ups” first. She hasn’t said anything about the BP component. I’ve chosen a surgeon experienced in this area and I’ve read everything I have been able to find on the topic. If there was a risk this would jeoradize my mental health, I wouldn’t do it.

I have an appt scheduled with her for later in the month once I have the sleep study and liver scan results back.

Will the surgeon ordered psych exam require that my private psychiatrist weigh in? I assumed so.

Usually there is someone in the program working with the surgeon who does the evaluation.

Thank you.

Yes, even though I’m going to a psych recommended by the surgeon, I know I will need to partner closely with my psych. I’ve asked each surgeon I’ve met with about the risks for BP patients and med absorption. The only one who took it at all seriously recommended the sleeve and said I would probably need to decrease dosages after losing weight. That said the literature I’ve seen suggests greater risks than that. I’d honestly rather be obese than have a relapse. It isn’t something I play with.

I’m meeting with my private psych in a couple of weeks to discuss this in particular. She has seen me through some rough patches so I trust her. I just don’t think she understands obesity and weight loss terribly well. She seems to think diet, exercise and appetite suppressants will do the trick. Perhaps for some, but not for me. I track calories religiously, and I can only lose at 900-1000 and I gain at 1300. Appetite isn’t my issue.

Anyway- could you tell me more about the challenges that you faced Post-surgery?

thanks again.