Facing Up to Depression After a Bypass
by Randi Hutter Epstein
New York Times Nov 27, 2001
For many people who have had coronary artery bypass surgery, regaining emotional strength is a tougher challenge than recuperating physically.
Traditionally, rehabilitation specialists working with bypass patients have focused on rebuilding weakened muscles after surgery. But recently, a few teams of cardiac specialists -- nurses, doctors and psychologists -- have begun to concentrate on the mental fatigue and overwhelming sadness that strike many patients.
There are no conclusive statistics about the incidence of depression after bypass surgery. Estimates vary widely from fewer than a third of patients to more than three-quarters. Some experts believe that the rate of depression after bypass surgery is much higher than that of other types of surgery, but not everyone agrees.
Fortunately, a vast majority of patients who do suffer emotionally recover within six months. Still, for those who have to deal with overwhelming gloom, the postoperative weeks can seem intolerable.
''I think there is a significant incidence of acute postoperative depression, which uniformly resolves in a period of weeks,'' said Dr. R. Scott Mitchell, professor of cardiovascular surgery at Stanford. ''I think the cause is entirely unknown, but it could be the psychological effect of anticipating the surgery; the prolonged time under anesthesia, which is about four or five hours; or the results of the heart-lung machine.''
In traditional bypass operations, the patient's blood is circulated through this machine, which does the work of the heart and lungs while the heart is repaired.
''There are several possibilities for depression,'' said Dr. Roy John, a professor of psychiatry and director of the brain research laboratories at New York University Medical Center. ''Atherosclerotic plaques in the aorta can get dislodged during surgery and shower the brain, possibly clogging vessels. Or, perhaps the anesthesia or the hypothermia during the operation alters brain chemistry.''
Dr. John is undertaking a study to examine people's brains before and after surgery using quantitative EEG, a computer analysis of electroencephalograms, which record electrical activity of the brain. He hopes to learn if there is an organic cause of postoperative depression and then to pinpoint those at risk.
A small study published in August in the journal Applied Nursing Research suggests that older patients and women may be most susceptible to depression after bypass surgery. The study, of 31 men and women, found that 65 percent of the patients were depressed three weeks after surgery and 26 percent continued to be depressed by 12 weeks.
''There are a group of people who get depressed and will get better, but we need to target those people who remain depressed so we can treat them,'' said Dr. Susan McCrone, one of the investigators and chairwoman of the department of health promotion and risk reduction at the West Virginia University School of Nursing in Morgantown.
Several hospitals are using a relatively new technique that replaces the heart-lung machine and allows the heart to continue beating throughout surgery. Doctors say those who avoid the heart-lung machine recuperate faster, both physically and mentally.