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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by sooshi on July 29, 2004, at 9:35:53
I'm having surgery under general anesthesia on Aug. 2. This will be my 4th time under general. The first time went fine. Second time, I came to, and within an hour felt the most unbelievable depression I've ever felt in my life...and this spiraled into a severe suicidal depression that lasted 6 months. Third time, I had some depression and anxiety, but handled it much better. No depressive episode. (BTW, I'm BPII). I warned the 3rd anesthesiologist about my diagnosis and previous post-op problems, but he didn't think anesthesia had anything to do with it.....I guess the personality of the dr. helps when it comes to getting some cooperation.....
Anyway, I'm wondering if anyone else has had this experience, and if there is anything I could do to possibly lessen the chance of another episode? I am on the same AD I've been on for the last three surgeries (Effexor XR), but different mood stabilizers - connection?
Any thoughts appreciated!
Posted by Sebastian on July 29, 2004, at 19:27:19
In reply to Anesthesia induced depressive episode...how avoid?, posted by sooshi on July 29, 2004, at 9:35:53
Have you ever undergone surgery with no anistesia? Do you still get the depresion? In the past when you had surgery and depresion after, were you taking any meds like effexor or...? If not then you are most likely you won't have depresion after. If so you might want to consider no anistesia or a powerfull med for directly after or during. You could prebably talk to your doctor about it.?
Posted by sooshi on July 30, 2004, at 22:23:01
In reply to Re: Anesthesia induced depressive episode...how avoid?, posted by Sebastian on July 29, 2004, at 19:27:19
Thanks Sebastian!
>>"Have you ever undergone surgery with no anistesia?"
NO! I have never undergone surgery without anesthesia! We're talking major surgery here...opening up my abdomen! I wouldn't even consider one of the alternative forms of anesthesia, such as hypnosis....nope, not for me! Not with this kind of surgery.
>>"In the past when you had surgery and depresion after, were you taking any meds like effexor or...?"
Yes, I was on Effexor XR after each surgery. I was on a different mood stabilizer after each one though, and will be this time too.
I have talked to my surgeon and pdoc and all they suggest is telling the anesthesiologist to "lighten up" with the anesthesia so that hopefully I won't get that kind of reaction again(bad depression afterwards).
The pdoc said he could treat me aggressively afterwards if it happens again, but jeez, I just want to AVOID it happening...it's just too painful.
I just thought someone might know the connection between anesthesia and it possibly messing with seratonin or norepinephrin, etc. or whatever would cause such a deep depression so immediately after surgery with general anesthesia.
Posted by chemist on July 30, 2004, at 22:42:56
In reply to Re: Anesthesia ....Chemist??, posted by sooshi on July 30, 2004, at 22:23:01
> Thanks Sebastian!
>
> >>"Have you ever undergone surgery with no anistesia?"
>
> NO! I have never undergone surgery without anesthesia! We're talking major surgery here...opening up my abdomen! I wouldn't even consider one of the alternative forms of anesthesia, such as hypnosis....nope, not for me! Not with this kind of surgery.
>
> >>"In the past when you had surgery and depresion after, were you taking any meds like effexor or...?"
>
> Yes, I was on Effexor XR after each surgery. I was on a different mood stabilizer after each one though, and will be this time too.
>
> I have talked to my surgeon and pdoc and all they suggest is telling the anesthesiologist to "lighten up" with the anesthesia so that hopefully I won't get that kind of reaction again(bad depression afterwards).
>
> The pdoc said he could treat me aggressively afterwards if it happens again, but jeez, I just want to AVOID it happening...it's just too painful.
>
> I just thought someone might know the connection between anesthesia and it possibly messing with seratonin or norepinephrin, etc. or whatever would cause such a deep depression so immediately after surgery with general anesthesia.hello there, chemist here....i had read your post and Sebastian's reply...undertaking a surgical procedure that is grand enough to warrant anesthesia seems to indicate that the old ``tough it out'' suggestion is not appropriate here. i am assuming you will be getting gassed-up with the latest and greatest fluoronated anesthetics, and from what little i know about this area, the field has only progressed in a positive way. in re: interactions, i am not aware of any that include mood stabilizers or the other drugs discussed with frequency on this board. i can state that you might be subjected to a multiple-drug anesthesis, such as midazolam + phenobarbital (i.v.), if the procedure is along the lines of removing impacted molars. if you are talking *major* surgery - such as in this case - i would suspect that the compounding element includes the very powerful painkillers administered during the tail-end of the operation and/or immediately following. the heavy-duty anesthetics are useful for the time they are administered: that's why the anesthesiologist is the highest-paid person in the room, because a little change in administration can be disasterous. in summary: i am not aware of the (already known) contraindications with anesthetics and the ``common'' psychotropics (however, check with your doctor and if another poster is, press them, as i am far from the fount of knowledge on this); grill your doctor, pdoc, and anesthesiologist pre-op, and make sure you give them the whole list, from OTC meds to supplements to the kitchen sink. more informed = better outcome. inquire about the post-op sedation, and go from there. apologies for the non-answer, but this is serious business that you must address with all your doctors.....please keep us informed, and all the best, chemist
Posted by sooshi on July 31, 2004, at 7:44:17
In reply to Re: Anesthesia ....Chemist?? » sooshi, posted by chemist on July 30, 2004, at 22:42:56
Thank you Chemist! I hadn't even thought of the pain killers that they administer at the end of surgery! I have already printed up as much info about my meds to hand directly to the anesthesiologist, especially since one of my drugs isn't well known at all (Zonegran...) And I plan on holding him/her hostage until I feel they understand the impact of what could possibly happen to me. But the problem is, you only get to meet with this person literally right before surgery (that's what my experience has been)...but I guess I could tell them to go look up contraindications of my meds and their anesthesia, huh!?
As for my pdoc, he's pretty much leaving it all up to the anesthesiologist. Same with the surgeon. Argggghhhh!
I guess I'll just keep my fingers crossed and hope for the best. I'm doing better now on this particular cocktail than I have in many years, so I have great hope that it will be enough to hold me steady after surgery. But with that great hope comes great fear of being knocked back down! There's almost nothing more painful than sinking into another depression after having a successful run with stability!
Posted by chemist on July 31, 2004, at 8:13:55
In reply to Re: Anesthesia ....Chemist?? » chemist, posted by sooshi on July 31, 2004, at 7:44:17
hello sooshi, chemist here...your pdoc is, in my opinion, correct in deferring to your anesthesiologist. the latter deals with this stuff all the time, as pretty much everybody is medicated with something, from cholesterol drugs to contraceptives to effexor and so on...and conversely, your pdoc does not have anesthesized patients strolling into the office day-to-day (i am assuming she/he has not medicated their patient load into a stupor). given my cursory read of the (standard) references i have (and they're not top-secret or special), effexor and zonegran don't show up with warnings concerning anesthetics, although the final word is with your anesthologist. in addition to the sedating pain killers, zonegran is somewhat sedating (i qualify this with a disclaimer that i'm reading this from my 2004 PDR, and nothing else, so it's not the most definitive info). surgery is tough on the body and the mind, so a touch of anticipatory anxiety and subsequent ``relief'' that manifests as ``depression'' might be what you're looking at. in any event, the anesthesiologist does deal with the medicated populace daily, so that should be comforting to you, and she/he will be able to flag anything should the need arise. and why not ask her/him about lightening up the post-op dope given your history, or make sure they know about it in detail: you are certainly not the first case they've seen in this regard. i hope all goes well and remember that surgeries are no different than any other physical trauma to your body with the exception that you saw it coming and know you'll be laid-up for a bit after.....all the best, chemist
Posted by sooshi on July 31, 2004, at 20:43:56
In reply to Re: Anesthesia ....Chemist?? » sooshi, posted by chemist on July 31, 2004, at 8:13:55
Oh thank you so much Chemist! Your remarks have really eased my anticipatory anxiety about this matter! I see that I have/will be doing as much as I can to get the best results possible, so I am just going to be as positive as I can post-op.
I believe you're a fellow Austinite, right? I'll be at St. David's on Monday...wish me luck!
Sooshi
P.S. No toll roads!
Posted by chemist on July 31, 2004, at 21:07:46
In reply to Re: Anesthesia ....Chemist?? » chemist, posted by sooshi on July 31, 2004, at 20:43:56
> Oh thank you so much Chemist! Your remarks have really eased my anticipatory anxiety about this matter! I see that I have/will be doing as much as I can to get the best results possible, so I am just going to be as positive as I can post-op.
>
> I believe you're a fellow Austinite, right? I'll be at St. David's on Monday...wish me luck!
>
> Sooshi
> P.S. No toll roads!hi sooshi, yes, austin it is...and i'll be breakfasting at the red river cafe while you're across the way, i imagine....i say no toll roads, and as our illustrious council and mayor are not involved with your procedure, you'll be in good hands at st. david's!....just take your complete list of rx/otc/herbs/etc. with you, soon you'll be able to tackle the hot sauce at guerro's......keep austin weird!!! all the best, chemist
Posted by sb417 on July 31, 2004, at 23:30:36
In reply to Anesthesia induced depressive episode...how avoid?, posted by sooshi on July 29, 2004, at 9:35:53
Hi Sooshi. I haven't read this entire thread yet, so forgive me if I'm repeating something that's already been mentioned. Do you know whether you were given any anti-emetics (anti-nausea drugs) with your anesthesia cocktail? General anesthesia can cause nausea; therefore, anesthesiologists often mix anti-nausea drugs with the anesthesia. There are several different types of anti-nausea drugs, including the ones that are routinely given to cancer chemotherapy patients. Some of the anti-emetics block the vomiting center in the brain, some antagonize or block serotonin 5HT-3 receptors in the gut, and then there are newer ones that I'm not familiar with. I know that those that block serotonin 5HT-3 receptors can cause depression, often quite severe. This happened to me, and my depression did not lift for six weeks despite taking many antidepressant measures (medications plus exercise, etc). If you get a copy of your operative report, you might be able to find out exactly what drugs were given to you by the anesthesiologist. Then, the next time you have surgery, you can discuss this with the next anesthesiologist so that you can try to avoid going through another anesthesia-induced depression. Also, remember that the body responds to the enormous stress of surgery as it does to other major injuries, and you need to slow down and let your body recouperate whether you are depressed or not.
Posted by sooshi on August 1, 2004, at 17:02:18
In reply to Re: Anesthesia ....Chemist?? » sooshi, posted by chemist on July 31, 2004, at 21:07:46
Posted by sooshi on August 1, 2004, at 17:04:23
In reply to Re: Anesthesia induced depressive episode...how avoid? » sooshi, posted by sb417 on July 31, 2004, at 23:30:36
Hi sb417,
Great info! I'm making a copy of your post and taking it with me. Thanks so much!
Sooshi
Posted by sb417 on August 1, 2004, at 22:17:20
In reply to Re: Anesthesia induced depressive episode...how avoid? » sb417, posted by sooshi on August 1, 2004, at 17:04:23
Hi Sooshi. I finally got around to reading the thread. I hope all goes well tomorrow! We'll be thinking of you. When you feel well enough, let us know how you're doing.
Posted by sooshi on August 6, 2004, at 10:57:50
In reply to Sooshi, posted by sb417 on August 1, 2004, at 22:17:20
I had major surgery with general anesthesia on Monday, Aug. 2, and so far, so good! I brought a detailed list of my meds to the anesthesiologist, who, at the beginning, really wasn't interested and felt that there would be absolutely no interaction between my meds and his anesthesia or anti-emetics, or any possible ensuing depression that might follow. He insisted that the gases were very temporarily in the brain, and were all the way expelled afterwards!? (then why do they make you get up and walk, cough, etc. to expel these *gases* after surgery??) But, upon MY insistence that he listen to my past history with a severe depression after having surgery with general anesthesia, and showing him some other "research" I had done, he lightened up a little, and said he would "do what he could....". I have no idea whether he really followed up on this promise or not, but I have so far not experienced any problems, other than expected mood downswings from painkillers, being confined to bed and indoors, etc.
I feel like I did the best I could under the circumstances, although next time I think I will definately try and find out who the anesthesiologist will be the day of surgery. This surgery just came up rather fast.(do hospitals use who is "on call", or does each Dr have their own anesthesiologist.....??)
I do think that because I am doing VERY well on my anti-depressant and mood stabilizer (Effexor XR and Zonegran) and have been stable for the past 5 months, I will have a heads-up in fighting off post-op depression.
Thanks to all for your concern. My surgery went well (had some abdominal tumors removed... PATHOLOGY REPORTS NEGATIVE! YEAH!) and am doing fine.
This is the end of the thread.
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