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Depression & Anxiety -

Depression is a state of brain or mind in which depressed mood is persistent i.e. it is not just a transient feeling or a bad day. Depressed mood can be experienced as feeling down, blue, sad, tearful, flat or empty and can range in severity from mild to severe. A clinical or major depression lasts at least two weeks and causes significant distressor decreased functioning in various areas of life (e.g. studies, work, social, relationships, leisure activities, self care.) The diagnosis is made on the basis of several criteria. Either depressed mood or a lack of sense of pleasure in things must be present most of the time. In addition there are symptoms of consistent tiredness, lack of energy, low motivation, low self esteem, pessimism, self reproach or guilt, thoughts about death or suicide, poor concentration, indecisiveness, disturbed patterns of sleep, appetite and libido, negative thoughts, lossof interest in usual activities and social withdrawal. There is often irritability and anxiety.

Major depression is associated with decreased activity in the areas of the brain responsible for regulating mood and is accompanied by characteristic decreases in the activity of certain neurotransmitters, viz. serotonin, noradrenaline and dopamine.

The long term consequences on untreated depression are many including: poor performance at work, with increased days off work; impaired relationships; poor quality of life; increased risk for several illnesses; many physical aches and pains; unhealthy behaviours including lack of exercise, substance abuse, eating poorly; and even death by suicide.

There is an increased incidence of depression in obese people the relationship between obesity and depression is complex and not fully understood. Depression makes people feel tired, unmotivated hopeless and negative. It is difficult to sustain exercise and dietary changes when in this state as everything feels overwhelming and too much effort.

Depression is also associated with a higher than normal risk of addiction as an attempt to shift negative mood by using cigarettes, alcohol, drugs, food, gambling, sex etc. In addition depression is associated with a higher risk of heart attack and type 2 diabetes. Patients with strokes also have a higher rate of depression than patients with other neurological problems. Current medical knowledge suggests that depression and atherosclerosis (narrowing of the arteries) may both involve an inflammatory process that damages arteries. Depression also alters the body's production of the stress hormone cortisol. Increased cortisol in turn increases the risk of hypertension, diabetes and weight gain.

Depression is also associated with increased activity of the fight-flight system in the brain and body. This increases constriction of blood vessels, high blood pressure and irregular heart beats.

Obesity can lead to an underactive thyroid (part of the metabolic syndrome) which can contribute to depression.

Obesity in turn may contribute to depression because of the multiple psychological and social consequences of being obese e.g. social rejection and stigma, limitations on activities the physical world not being designed to accommodate the obese (chairs are too small and lack robustness; clothes don't fit) - the recurrent experience of failure at controlling eating and weight poor self image, even to the extent of self loathing or disgust.

Chronic feelings of frustration and helplessness may be specific to the weight issues. If so, they will largely resolve after bariatric surgery. However these factors can lead to, or contribute to-, a major depression which would not disappear after surgery. Major depression needs to be treated independently of any weight intervention.

The psychiatrist and the clinical psychologist are available to provide medication and psychotherapy while the bariatric patient confronts and resolves the heavy emotional burden they which has been have carried for many years. It is vital to understand that weight loss surgery is not a cure for depression, but can along with hard work and compliance with the treatment guidelines assist the individual towards acquiring a healthier and more meaningful lifestyle.

The time following surgery is likely to be challenging. As the physical pain and anaesthetic wears off, the individual might find themselves feeling depressed. They are likely to experience depression as their body and mind mourn the loss of the previous relationship they had with food. These feelings are very normal and should be expected.

There is a good likelihood that, prior to joining the bariatric programme, the individual will have been turning to food when they feel anxious or stressed. Should they not posses s the behavioural coping mechanisms for dealing adequately with anxiety, they will struggle to adapt to the numerous changes that follow surgery. All change is difficult, despite most of the changes following weight loss surgery being for the better. Should it be evident that their anxiety levels are significant preceding surgery, psychotherapy sessions will provide them with an opportunity to acquire the skills to deal correctly with situations that evoke anxious feelings and thoughts. Medication might also be necessary, but not to the exclusion of developing good coping skills.