Emotional and psychological health is commonly overlooked when it comes to preparing for surgery. So, if you are scheduled for lower back surgery, you may be surprised to learn that clinical depression can adversely affect both the process of your surgery and your recovery.

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man with insomnia Chronic back pain can lead to depression, but so also can depression lead to chronic back pain.
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Depression Can Lead to Chronic Back Pain

This raises a compelling question: Should you postpone your lower back surgery if you are depressed? It is understood that everyone with spinal pain will have some emotional upset (e.g. mild depression or anxiety due to the pain and its effects on your life). However, what we are discussing is depression that goes beyond mild sadness or dysphoria.

See Depression and Chronic Back Pain

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What is clinical depression?

Before we look at whether or not you should postpone your back surgery, let’s quickly define clinical depression. Clinical depression is not simply a feeling of sadness that lasts for a day or two and fluctuates with your pain. Instead, clinical depression is a prolonged experience, and may include any number of the following symptoms:

  • A pervasive and daily melancholy mood
  • Decreased or increased appetite
  • Feeling hopeless and helpless
  • Excessive sleep, or an inability to get enough sleep
  • Diminished sex drive
  • Difficulty with concentration
  • Decreased energy
  • Thoughts of suicide/and or death

See Depression Symptoms

Although clinical depression can occur for a number of reasons, it is often brought on by a major life event. This might include the loss of a job, the death of a friend or family member, and, of course, the effects of long-term, chronic lower back pain.

See Depression Causes

Is it possible to postpone your surgery?

In some cases, postponing a spine surgery is not possible. For example, you may have a lower back condition that requires immediate action—such as cauda equina syndrome or a spinal tumor.

See When Back Pain May Be a Medical Emergency

However, in many cases it is possible to postpone a lower back surgery. So, if you suspect you might be suffering from clinical depression, the first step is to talk to your surgeon. Let her or him know you would like to get a consult with a mental health professional, and see if your surgeon has any recommendations.

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Spine surgeons will often work with mental health professionals that have special expertise in depression and/or anxiety as it relates to spine pain. If not, you can seek out a qualified professional to have your depression evaluated and treated prior to your surgery.

See Psychotherapy for Depression

Patients often believe that once their pain is relieved after surgery, their clinical depression will go away. Unfortunately, this is often not the case since the depression can take on a life of its own.

See Diagnosis of Depression and Chronic Back Pain

Should you postpone your surgery?

If you suspect you suffer from depression, it is best to have it addressed before your operation. If a qualified mental health professional confirms that you are clinically depressed, I recommend you postpone your surgery and get the depression treated. My reasons are simple: if you suffer from clinical depression, undergoing spine surgery may lead to continued or more severe depression post-surgery. Additionally, depression can actually make it more difficult for you to recover after your surgery. This is due to actual physical aspects of your depression which can impact your healing; such as difficulty sleeping, decreased energy, etc.

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The psychological aspects of depression can also impact your recovery, including low motivation for post-operative exercise, or an inability to perceive improvements in your health.

See Practical Advice for Recovering from Back Surgery

So then, it is important to take all the time you need to receive proper treatment for your depression before undergoing surgery. You may find that your mental health professional recommends beginning the treatment for depression prior to surgery, and then continuing treatment throughout your post-operative recovery.

How depression is treated

If your depression is in the moderate to severe range, you may benefit from counseling (often cognitive behavioral therapy or thought changing) and antidepressant medication. These techniques include challenging negative self-talk, which, in turn, improves self-esteem and decreases depression. If your depression is mild, you can likely forgo medication and be treated with various cognitive techniques and/or counseling. Your treatment might also include teaching you psychological pain management techniques that you can use to help with your recovery from surgery.

See 11 Chronic Pain Control Techniques

In most cases, attempting to self-treat your own depression is not successful. Instead, it is important to work closely with a qualified mental health professional.

After your depression has been successfully treated, or brought under reasonable control, you can then work in tandem with your mental health professional and surgeon to reschedule your surgery and mentally prepare yourself. In most cases, your mental health professional will want to follow you through the surgery process and recovery. This is to make sure that your depression doesn’t return or exacerbate and threaten the surgery outcome.

See How to Prepare Psychologically for Back Surgery

Learn more:

4 Tips to Help Cope With Chronic Pain and Depression

Preparation Before Back Surgery