Depression after knee and hip replacement surgery can take anyone by surprise. Even with the ups and downs you’ve experienced with joint pain and surgery, nothing can prepare you for feeling depressed in your recovery. The subject of post-op depression is seldom discussed between patient and orthopedic surgeon before joint replacement surgery. This makes depression during recovery even more confusing and isolating for the patient. However, despite not getting a lot of airtime, depression after hip replacement and knee replacement surgery is actually quite common.
Studies show that depression in total knee replacement patients is higher than other surgery patients.
For many joint recipients, feeling depressed after surgery can come as quite a surprise. It can be as scary as it is bewildering. After all, a joint replacement is often looked at as a “new lease on life” or a “life-giving” surgery. Feelings of sadness, sorrow, loss of interest, and mood swings don’t fit into this equation! Unfortunately, this isn’t true. The depression curve ball does fit into the equation, affecting 50% of knee replacement patients in a small controlled study.
Can you imagine if another joint replacement complication affected anywhere close to 50% of patients? Surely it would be a major talking point amongst patients and their providers, fellow patients, at-home caretakers and so forth. Read on as we openly breakdown the “what” and “why” or post-op depression and what you can to do to combat it.
What is Postoperative Depression?
Depression is a disorder that plagues you with unexplained sorrow, prolonged sadness, and/or a general disinterest. These feelings can persist for an extended period of time, affecting your mood, behaviour, energy level, and physical well-being. It can interfere with your desire to be social, to resume the activities you usually enjoy, and overall, makes you and everything around you feel “blah”.
Hip replacement recovery depression or knee replacement recovery depression (post-op depression) can impact patients at any point during their recovery from surgery. A wave of depression can hit in the hospital, after a few days at home, or even weeks after surgery. Everyone is different, and the degree to which they experience a bout of depression, the length of time they feel depressed, and how they overcome it is dependant on the individual.
Symptoms of Post-Op Depression
- General fatigue. Feeling too physically and/or mentally exhausted to carry out normal activities.
- Sleeping more than usual. On the flip-side, depression can lead to insomnia, or sleeping less than usual.
- Indecisiveness. Nothing feels quite like the right decision, and you don’t have a clear mind.
- Change of appetite. Eating more or less than usual.
- Lack of Interest. Loss of interest in the things you usually enjoy. This could be chatting on the phone with friends, playing cards, reading, spending time with family etc. Simply, you don’t feel like doing any of it or you’re “forcing” yourself to.
- Not feeling like yourself. Feeling more anxious, stressed, irritable, aggressive or angry than usual. You may feel as though you’re wound up tight or on a short fuse.
- Feeling hopeless and lost. You feel like there’s nothing for you to look forward to. You feel like the future is grim and that you won’t get over your current state.
- Feeling alienated and alone. You don’t feel like speaking out because you feel like no one understands what you’re going through.
- Thoughts of harming yourself or others. On the extreme, you may have suicidal thoughts or thoughts of self-mutilation. This can translate into wanting to hurt others.
*Note: If you’re feeling depressed and/or are having suicidal thoughts or thoughts of harming others, reach out to a mental health provider near you. They can help.
Why am I Depressed After Hip Replacement or Knee Replacement Surgery?
If you think about how mental illness, stress or anxiety can bring about physical ailments and disease, the same is true in reverse. In other words, after a physical trauma to the body, like joint replacement surgery, an emotional healing needs to take place as well.
We spoke to Mani, a therapist and anxiety expert who’s authored an award-winning book entitled “Journey from Anxiety to Freedom”. She herself recently underwent a knee replacement and described how surprising her emotional healing process was.
Mani, hypnotherapist and anxiety expert, explains, “You don’t hear as much about the fact that it took a month before I began feeling like myself. Some people they say, ‘well, you’re on narcotics’ but this was not the case for me. It takes a while to feel like yourself again. I didn’t think I had my clarity of mind. It was a part of the recovery process I hadn’t anticipated.”
Depression can be linked to numerous things a after surgery that create “the perfect storm” for your mental health. Having a surgery is traumatic on your body, causes pain, means you’ll be taking unfamiliar medications, makes you more dependent on others, means you’ll be housebound etc. All of these things are contributing factors to feeling depressed.
Here are the factors contributing to joint replacement post-op depression:
- Reaction to anesthesia. According to Dr. Mary Shinn, MD, “Post-surgical depression can be from the after effects of anesthesia (anesthesia tends to bring out our “sensitive sides” and our anxiety).”
- Anticipation and adrenaline are over. Dr. Mary Shinn also talks about the “Surgical Let Down Period”, where you’ve waited so long for the surgery and now it’s over. You’ve been anxious, stressed about it, and even excited. Now, the adrenaline has worn off, you’re in bandages, in pain, and your life hasn’t improved as dramatically as you’ve envisioned.
- Pain and discomfort. Feeling physically terrible doesn’t just affect your body—it affects your mind. Being in pain is something that you physically and mentally endure. It’s hard to stay positive when you are hurting.
- Narcotic painkillers and other medications. Although effective at combatting pain, there is a rap sheet of negative side effects from narcotics. A known side effect of many of these narcotics is depression, anxiety and even suicidal thoughts.
- Poor sleep/ Insomnia. After surgery, it can be next to impossible to get a good sleep while following the proper hip and knee precautions. If you’re not getting to sleep and staying asleep, it can greatly affect your mood and trigger a bout of depression.
- Feeling dependent/ “cabin fever”. Having decreased mobility and feeling a lack of independence can make anyone feel “down in the dumps”. Pair this with being stuck at home for days or even weeks as you recover and it’s hard to feel like yourself.
- A history of depression and anxiety. If you had pre-surgery anxiety or have a history or anxiety, depression, or other mental illnesses, your chances of feeling depressed after surgery are greater. Surgery can trigger anxiety, stress and depression.
Note: If your reading this article on behalf of a loved one, he/she may not be recognize their own depression. Major depression can be life-threatening. Talk to a professional about getting help for your loved one.
How to Overcome Post-Op Depression
Coming to grips with feeling depressed can be tough for a lot of people. It’s hard to admit to yourself (and others) that you’re not at your best. However, know that there’s no shame in your game—depression is a common side-effect of a major surgery. Also, know that there shouldn’t be any judgement admitting to others how you feel or even in seeking out some professional help.
Here are some things that you can do and tips to work through feelings of depression after hip or knee replacement surgery.
1. Acceptance: Your Situation is Temporary
The more that you can accept that the way you’re feeling is part of your healing process and is something that is felt by thousands patients across the country, the more honest you can be with your feelings. After all, we are writing this post for a reason: because feeling depressed after surgery is a thing.
Know that you are not alone or failing because you feel the way that you do. You’ve gone through enough as it is, you don’t need to complicate anything further by avoiding how you feel or being mad at yourself.
2. Reaching Out to Friends and Family
Isolating yourself from family and friends is dangerous. Pulling away from those who offer to help you and not opening up to those you trust when asked “how are you doing?”, can make you feel more alone. Let your family and friends lift you up and support you. Being around people that you love and care about will lift your spirits and increase your feelings of wellbeing.
Remember that most people have felt some form of depression at one time or another, so don’t be ashamed of talking it out. Your loved ones want to help you.
3. Getting Better Sleep
It sounds easier said than done, but sleep has a huge impact on your mental health. Make sure that you are “optimizing” yourself for a good sleep after joint surgery by following up with your prescribed pain medication regimen, removing electronics from your room, avoiding alcohol, avoiding caffeine etc. Doing something relaxing before bed, such as reading or writing in a journal can also help you fall asleep and stay asleep.
With your doctor’s permission, you may be able to take over-the-counter sleep aids, such as melatonin or diphenhydramine (Benadryl).
4. Exercise, Exercise, Exercise!
We get it. When you’re feeling depressed the last thing you want to do is get up and move…but…you gotta. Getting active is one of the best things you can do. By staying on top of your recommended ReHab exercises, you will not only be propelling your recovery forward, but you will improve your mental health, relieve stress, and boost your overall mood.
Keeping up with your at-home ReHab exercises, participating in regular physical therapy, and gradually adding some walking or other light cardio will kill many birds with one stone. Use exercise as an outlet to release some of your negative energy. After all, while your body is busy, your mind can relax.
5. Monitoring and Sharing Your Symptoms
It’s important to keep track of how you feel, the medicine you’re taking, and monitoring any symptoms you may experience. Jotting down your activities, the medication (both prescribed and over-the-counter), the exercises you do, how you’re feeling etc., will give you a better handle on your situation. Monitoring each day’s activities and tracking symptoms will reveal when you’re feeling good (or not), and what activities or medications could be linked to how you’re feeling.
Documenting this information is not just good for your own deduction and records, but can be shared with your physician. Sharing how you feel with your physician by detail your symptoms will let them better treat you.
6. Knowing What to Expect
For those into their joint replacement recovery, this ship may have sailed. However, the more you know about the surgery itself and the recovery period, the more prepared you will be for what’s to come. Being better prepared reduces overall anxiety and leaves you better equipped to handle the recovery process. A lot of patients, especially those who’ve had a knee replacement, really aren’t aware of the downtime and full extend of the recovery. This can cause feelings of hopelessness, frustration, and stress.
By managing expectations of what you realistically can do or should be doing after surgery, you can better prepare yourself and avoid some disappointment.
7. Get Professional Help
If you’re at your wit’s end or feel like you need some professional help to get back on track, reach out to your care team. Your orthopedic surgeon or primary care physician will be able to recommend helpful resources to you. Your physician may switch your pain medication or prescribe something to treat depression—both options could effectively combat your depression.
Beyond medication, other treatments like therapy, acupuncture, and herbal remedies can be quite effective. Seeking out a therapist, counsellor, support group, or other profession that treats depression can offer the outlet and guidance you may be lacking.
