Post operative depression (post surgical depression) following ACDF

KittyLizKKittyLiz MainePosts: 35
My dual level ACDF (cervical fusion) surgery went off without a hitch.  I spent one night in the hospital, left with no cervical collar, had the expected sore throat, and was driving within a week.  After five weeks, I started physical therapy and the upper thoracic and trapezius pain in the neck is gradually dissipating.

The one thing I did NOT expect at all was a bout with depression. Although the surgery and recovery went exactly as the surgeon predicted (and even better than my own expectations), I slid into stages of frustration, anger, and finally depression.  By the time I suspected it was related to the surgery, I was gradually pulling out of it.  It took about 7 weeks from the start to return back my own level of a normal mood.  Once I suspected the problem (equating it in my mind to postpartum depression), I researched it online.  In my personal experience, I suspect it was related to the prednisolone (medrol pack) which was prescribed to reduce inflammation and swelling.  I mentioned the depression during my 4 week follow-up and the response was "yeah, that can happen".  At age 60, I've had a couple of other major surgeries, and don't remember this response. In my research, I found that post-operative depression might be caused by the anesthesia, pain medications, and the trauma of the surgery itself, although the articles waffled on pinpointing the exact root of the depression.  Apparently some people are more susceptible - those having previous episodes of depression, people with chronic health issues (I have fibromyalgia), and especially cardiac patients.

Had I been familiar with this not uncommon side-effect of surgery, perhaps I would have been more open about it with my family and maybe it would have caused a little less turmoil in my household.  As it was, I didn't admit it until it was almost resolved.


  • Ellen625EEllen625 New Jersey, USPosts: 754
    Hi kittyliz
    I experienced this as well. Fortunately, I had joined this site and found it was not uncommon. I am not going to lie, I hid it from my family as best as I could. I would wait until my husband went to work or tell people I had to go rest and then cry. Fortunately, it went away.
  • MagistraMarlaMMagistraMarla San Antonio, TexasPosts: 78
    I experienced much the same thing.  I had post-surgical delirium the first night after surgery.  I woke up and saw strange multi-colored flashing lights and was irrationally afraid, but went back to sleep.  The next time I woke up, I thought that I was drooling because my pillow was wet.  I then realized that the whole bed was wet and that I had pulled out the IV and the drain in my back.  I reached for the nurse call button, but found that I had knocked it off, along with the pain button.  I focused on the window looking into the hall with a clock above it, and finally saw a nurse look in 40 minutes later and started waving my arms and screaming "Help!".  The next day I found out that what had scared me was the hospital helicopter coming in for a landing.  If only my husband had stayed with me, he could have told me that, and soothed me back to sleep.
    I've never been depressed before, but I was for about 5 weeks after I got home.  The doctor had told my husband that there was no need for him to take FMLA, so he went back to work, leaving me alone.  I was suicidal twice.  Like you, I started researching and found one source that said that the anesthesia that they use to keep us immobile for such a long time can cause delirium and depression, since it takes a long time to clear the system.  I didn't have a medrol pack, and I can't blame pain meds, since I'm allergic to opioids and only had Tylenol for pain.
    I also have chronic health problems, including RA and Sjogren's Syndrome.  I read that post-surgical delirium is common in the elderly and in people with autoimmune issues, which is what I have.  The article said that it is important that those people eat a nutritious meal and stay hydrated the day before the surgery.  I was so petrified the day before that all I had was a cup of yogurt for breakfast and nothing else the rest of the day.  It also stressed the importance of having an advocate stay with you at the hospital.  The doctor told my husband to go home, so I was alone.
    I have to have a revision surgery, since my fusion failed.  I'm definitely NOT going back to the same surgeon or hospital! My husband has promised to be there for me for the whole ordeal, and to take as much FMLA as possible this time.  It's difficult for me to believe him, since that awful experience has made me lose a lot of trust.
    You would think that there would be some counseling available at the hospital about all of this beforehand, to prevent this sort of thing before it happens, wouldn't you?
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  • There was some screening at the hospital ahead of time - did I have a good support system, was I afraid at home, and I can't remember if there were some depression screening questions. But nothing clicked in that depression might happen as a result of the surgery.  I think I was caught off guard - not knowing how common the post surgery depression can be, even with a perfectly good outcome physically.  I have since discussed it with my family (when I was almost all better), because I finally realized keeping secrets like that has power over me.  Mostly it was well received, a few unwanted suggestions about organizing my life... but better having it out in the open for the most part.  I think having been through it, I would be able to cope with it better if it happens again during a future surgery.

    I don't envy your struggle with the delirium and fear.  My hospital experience was actually quite good.  My sister stayed with me the entire day, and I was quite self-sufficient by the evening.

    Perhaps by bringing it out in forums like this, we can help other people (and ourselves) in the future to be prepared.  I hope that you will be able to face your revision with a little more confidence, especially since you and your husband are taking measures to keep you safe.

    I plan to send an email to my surgeon after I finish physical therapy (with my progress update) and suggest to him that people should be warned to call immediately if depression is experienced.  I should have raised the red flag for help, instead of handling it on my own for so long.  I will also tell the same thing to my PCP during my upcoming physical.
  • My lesson for myself is to NOT hide it if it happens again.  Secrets hold power over us, and no matter the fallout from revealing my problems, it was actually worse trying to make believe it wasn't happening.  I was very lucky that any negativity was pretty minor after I told a couple of family members about the depression.  Fortunately, I was able to laugh when my mother blurted out to my boyfriend "Did you know she had depression?"  I replied - "No he didn't because I didn't tell him yet!"  Fortunately he was unflappable and just said it was common and he wasn't surprised.  Phew!
  • MagistraMarlaMMagistraMarla San Antonio, TexasPosts: 78
    Like you, I didn't discuss it with my husband or anyone until I was doing better.
    There were two things that helped me to shake off the depression.  First, my youngest daughter walked in with a tiny kitten who had been found alone in a parking lot in the rain, covered with mud and fleas.  She was just what I needed - a tiny being to take care of!  I held her and fed her kitty formula until she weaned to wet cat food.
    The other thing was that our local pool opened, so my oldest grandson came to spend most of the summer with me.  He has been on the swim team since he was 5.  That summer was his last one as a swim team member.  Now that he has aged out (17), he came back as a lifeguard and swim coach this summer.  I started going down to the pool with him so that I could do water aerobics, and I'm still going this year.  (It stays warm well into October where I live).
    The combination of being with my friends at the pool and having my grandson around kept me from having those dark thoughts all day.  I was also happy to watch Leia grow into a beautiful cat.
    This summer, the lifeguards found a tiny kitten hanging in the fence.  Of course, my grandson brought her to me.  She has nerve damage, so the vet plans to amputate that leg when he spays her.  We're planning to wait for that until just after we get home from my surgery, so that Gigi and I can recover together.
    I'm a bit more hopeful this time, since the hospital I'm going to this time does seem to be better.  The hospital system is very careful to screen patients.  I've already had to pass a check-up by the hospital internist so that he could clear me for surgery.  I'll also have a hospital pre-op the day before surgery.  The previous hospital was a large trauma center.  I'm guessing that they have the attitude that any issues will be dealt with as they come along rather than attempting to prevent them, because they are geared toward dealing with emergencies and accept anyone who comes in.
    My new hospital is a small orthopedic-only hospital that shares an ER with a heart specialty hospital next door.  It's located in a quiet suburban neighborhood, but is affiliated with the major trauma hospital in the city nearby.  I think that I will find the stay more restful this time.
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  • Three legged kitties.

    My friend,me has the inability to pass by any cat without petting or adopting it
    Has a lil guy whome lost his leg due to a fence accident.
    He figured a dog chased him up and fell between the boards. who a kitten is the very delight of my life petted the little ball of sunshine and felt he had a pin missing!
    My buddy came in and laughed at my look.
    And told me how he and his best gal had rescued kitteh!

    Kitties are my kryptonite!!!
  • MagistraMarlaMMagistraMarla San Antonio, TexasPosts: 78
    LOL - We are just alike.
    We have a flame point Siamese who is 13 years old.  My husband's baby is a beautiful 11 yr old Maine Coon who has 7 claws on both front feet and 6 on the back paws.  He is totally spoiled.
    Laia is a Lynx point Siamese and Gigi is black and white.
    My retired service dog is also now handicapped.  He's a huge German Shepherd.  He skidded down the carpeted stairs while playing with a couple of grandsons and hyper-flexed his paws.  He's too old for the surgery, so he happily lives a quiet life with the kitties.  Laia shares his bed with him.
    My heart wants to save every animal in need!
  • smartens162smartens162 Manitoba, CanadaPosts: 361
    I have had several surgeries (5+) in my lifetime (I'm 46) and I can tell you that with every one, depression followed.  I believe that the anesthesia is the biggest culprit, as the variables for each surgery were different, but the anesthesia was a used for all of them.  Simply knowing that this is a strong possibility for me going into surgery is helpful (knowledge is power).  
  • I agree, smartens162.  Knowledge is power.  Also, research shows that hospitalized people who have a pet do better.  I am done with pets, but I do see the benefits.
  • smartens162smartens162 Manitoba, CanadaPosts: 361
    maybe you have a friend with a pet that could share some snuggle time :)
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