In the United States, approximately 21 million adults suffer from depression every year (1). Characterized by a wide array of emotional, physical, and neurological symptoms — including persistent feelings of sadness, irritability, inability to concentrate, lack of appetite, fatigue, neurocognitive dysfunction, and chronic pain (2, 3) — depression is associated with disability, decreased quality of life, and reduced survival (4). Moreover, due to its effects on the body as well as the brain, depression may also alter physiological processes, potentially leading to immune system dysfunction, poor overall health, and worse postoperative outcomes (4).
The connection between depression and postoperative outcomes remains an area of active investigation. While a growing body of evidence suggests that patients with depression before various types of surgeries are more likely to experience postoperative complications — including readmission, chronic pain, neurocognitive dysfunction, and higher medical costs (4-6) — other studies have failed to find a correlation (7, 8). Given this contradiction, researchers at Northwestern University sought to investigate the complex relationship between depression and postoperative outcomes in the context of cardiac surgery patients. By comparing patients’ scores on the Beck Depression Inventory before the surgery versus one month after, the team discovered that preoperative depression was not significantly associated with negative postoperative outcomes (9). However, higher postoperative depression scores were positively associated with neurocognitive dysfunction, i.e., impaired memory, attention, and processing speed (9). While the results of this study contradict some earlier findings in other fields of surgery, researchers generally agree that depression negatively affects the quality of life of postoperative patients, even if the consequences are not physical.
The high prevalence of depression in cardiac surgery patients especially, as well as the demonstrated effects of the condition on postoperative outcomes, have raised concern among cardiac surgeons and cardiologists (10). Some researchers have suggested that pathophysiological mechanisms related to depression may also affect cardiovascular pathways, e.g., inflammatory processes and platelet activation (11). Therefore, to help patients recover both physically and mentally, researchers now recommend screening for depression before and after cardiac surgery and providing personalized mental health care (9). While no studies involving pharmacological depression treatments have been published in recent years, cognitive behavioral therapy and stress management support programs have been shown to improve depression scores in cardiac surgery patients (12). Overall, the introduction of mental health screening and interventions into routine cardiac care may improve postoperative outcomes as well as the psychological and physical wellbeing of cardiac surgery patients.
1: Adams, T., Asman, K., Barnett, S., Bradshaw, M., Brown, K., Burner, G., Campbell, W., Carpenter, L. et al. (2020). 2020 National Survey of Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration (SAMHSA). Report. URL: https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases.
2: Kennedy, S. (2008). Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues in Clinical Neuroscience, vol. 10, p. 271-277. DOI: 10.31887/DCNS.2008.10.3/shkennedy.
3: Goodwin, G. (2006). Depression and associated physical diseases and symptoms. Dialogues in Clinical Neuroscience, vol. 8, p. 259-265. DOI: 10.31887/DCNS.2006.8.2/mgoodwin.
4: Ghoneim, M. and O’Hara, M. (2016). Depression and postoperative complications: an overview. BMC Surgery, vol. 16, p. 5. DOI: 10.1186/s12893-016-0120-y.
5: Wilson, J., Farley, K., ,Erens, G., Bradbury, T. and Guild, G. (2021). Preoperative depression is associated with increased risk following revision total joint arthroplasty. Journal of Arthroplasty, vol. 35, p. 1048-1053. DOI: 10.1016/j.arth.2019.11.025.
6: O’Connell, C., Azad, T., Mittal, V., Vail, D., Johnson, E., Desai, A., Sun, E., Ratliff, J. and Veeravagu, A. (2017). Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes. Journal of Neurosurgery, vol. 44, p. E5. DOI: 10.3171/2017.10.FOCUS17563.
7: Theologis, A., Ailon, T., Scheer, J., Smith, J., Shaffrey, C., Bess, S., Gupta, M., Klineberg, E., Kebaish, K., Schwab, F. et al. (2016). Impact of preoperative depression on 2-year clinical outcomes following adult spinal deformity surgery: the importance of risk stratification based on type of psychological distress. Journal of Neurosurgery, vol. 25, p. 477-485. DOI: 10.3171/2016.2.SPINE15980.
8: Navarro-Garcia, M., Marin-Fernandez, B., Carlos-Alegre, V., Martinez-Oroz, A., Martorell-Gurucharri, A., Ordonez-Ortigosa, E., Prieto-Guembe, P., Sorbet-Amostegui, M. et al. (2011). Preoperative mood disorders in patients undergoing cardiac surgery: risk factors and postoperative morbidity in the intensive care unit. Spanish Journal of Cardiology, vol. 64, p. 1005-1010. DOI: 10.1016/j.rec.2011.06.009.
9: Lewis, C., Dokucu, M., Brown, C., Balmert, L., Srdanovic, N., Madhan, A., Samra, S., Csernansky, J., Grafman, J. and Hogue, C. (2022). Postoperative but not preoperative depression is associated with cognitive impairment after cardiac surgery: exploratory analysis of data from a randomized trial. BMC Anesthesiology, vol. 157. DOI: 10.1186/s12871-022-01672-y.
10: Tully, P. and Baker, R. (2012). Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. Journal of Geriatric Cardiology, vol. 9, p. 197-208. DOI: 10.3724/SP.J.1263.2011.12221.
11: Amadio, P., Zara, M., Sandrini, L., Ieraci, A. and Barbieri, S. (2020). Depression and cardiovascular disease: the viewpoint of platelets. International Journal of Molecular Sciences, vol. 21, p. 7560. DOI: 10.3390/ijms21207560.
12: Freedland, K., Skala, J., Carney, R., Rubin, E., Lustman, P., Davila-Roman, V., Steinmeyer, B. and Hogue, C. (2009). Treatment of depression after coronary artery bypass surgery: a randomized controlled trial. Archives of General Psychiatry, vol. 66, p. 387-396. DOI: 10.1001/archgenpsychiatry.2009.7.