Ask Bella: Fatigue and depression

Q: I appreciate your discussion of fatigue and depression post surgery, and hope you will continue to raise this concern in your forthcoming blog updates. Depression and fatigue are two matters that I am worried about because I already struggle with these difficulties. I would appreciate learning more about the strategies you have used (or that others have used) for managing fatigue and depression after surgery.

A: Thank you so much for this question. I've noticed that a fair amount of people who find my blog through Internet searches are looking for information on this topic, and I also know that this is one of those things not a lot of people want to talk about, because of the stigma attached to depression.

For those of us who already struggle with fatigue and depression (myself included) on an ongoing basis, surgery can trigger these problems, which, in turn, can lengthen the recovery period.

I had a physiotherapist who told me once that many of the people she saw in rehabilitation programs (after major car accidents, injuries, etc.) were having serious mental illness problems. The way she put it was that everyone has his/her breaking point - there is only so much the mind can take. So, some people may be coping with regular everyday life just fine, but intense stress, such as that caused by a physical injury or illness, will push them over that edge.

I found that piece of information very interesting, particularly because I know how regular stress can affect my ability to cope with everyday life. That was part of the reason I worked so hard at being educated and mentally prepared for the surgery, with the determination to stay as positive as I possibly could about it. Unfortunately, even with my best efforts, I did plunge into depression and have been struggling with that combined with fatigue for this past year.

I don't say this to scare anyone with mental health problems from having this surgery - I still believe the positives far outweigh the negatives. It's just that I now have an additional level of healing to deal with than others who have had the same surgery.

In addition to mentally preparing yourself and having a really good understanding of what you're getting into, there are some other preparations you can make to deal with depression, post-surgery or otherwise:

Supplements: There are a number of supplements I take to help with depression/anxiety and I find they do help (please check with your doctor before taking any supplements):

• B Complex - I take B50 complex twice a day (with meals). It's good for nerves and I find I deal much better with life when I'm on it. On the plus side, it can also help your nerve endings repair themselves after surgery.


• Vitamin C - I take 1,000 mgs twice a day (with meals). Taking up to 3,000 mgs, from what I understand, is helpful with depression.


• Omega 3 Fatty Acids - I take 1,000 mgs of salmon oil (you could substitute other fish oil or flax seed oil - liquid or caplets) twice a day (with meals). This is one of the few supplements psychiatrists agree really help people with mental health issues.


• Vitamin D - I take 2,000 mgs once a day (with breakfast). Those of us in more northern climates don't get enough of this essential vitamin because we don't get as much sunlight. This is especially important in the winter and Vitamin D deficiency may be a cause of seasonal depression.


• Calcium/Magnesium - If I'm having problems sleeping due to stress, I will take a calcium supplement (1,000 mgs, with a small snack) before bed. The reason you want a calcium/magnesium combination supplement is that calcium on its own can cause constipation.

Know the physical symptoms of depression: It's easy to slip into depression without knowing it. It can kind of sneak up on you. Sometimes, I have the classic symptoms and I know right away when to start seeking help. After the surgery, I just thought I was exhausted and had the flu all the time (for months and months and months, which should have tipped me off.) It was only after I went back to my doctor for numerous tests (once the anemia issue was cleared up) that she suggested that I may actually be depressed instead of having something physically wrong with me.

Seek medical help: Going to your doctor to talk about depression can be scary and intimidating if you've never done it before, or even if you have. No one wants to have to say those words. Then again, they can be very empowering because by speaking the truth out loud, you are able to do something about it. Get checked out for the other physical possibilities that could be causing the symptoms - your doctor will know what to look for (such as anemia, thyroid problems, etc.)

Get a specialist: If you have a history of mental health issues or have mental health problems running in your family, it's a good idea to have a psychiatrist. They know the drugs a lot better than general practitioners do, and you want someone with knowledge on your side for those situations where a family history may make your case a bit more complicated.

In my opinion, it's even better to get yourself in with a specialist when you're in a good place and not in crisis (i.e. well before the surgery.) In doing so, you can develop a relationship with your psychiatrist before something happens, and he/she can get to know you when you're at your best. That way, you are less vulnerable when something happens and have a better chance of being an active participant in your own care. Not to mention that there are usually long waiting lists for specialists (here in Saskatchewan, it's 8-9 months to get in with a psychiatrist when you're referred by a family doctor!!)

Therapy: Talking to someone can help get the weight of the world off your shoulders and give you some perspective on stressful situations. In some cases, this can be enough to keep you from sliding down into depression. In others, it can help you manage the depression and claw your way out. There are really no downsides to this. Get it all out!

Drugs: Along with the medical help and psychiatrists are, you guessed it, drugs. Some people are really against this route. I have been one of those people in the past. However, I got to a point where I could no longer function in everyday life and the only way I could get out of bed, make it to work and be even remotely social was to start taking antidepressants.

Not saying that this is the choice for everyone, but I didn't really have a choice. I fought it for a long time, because of the stigma, because of the fact that I didn't want to admit that I had something that I had seen others in my family struggle with, because I wanted to be "stronger" than that and pull myself out of that pit with my own sheer willpower.

This illness is something that runs quite rampantly in my family, and I had to face the reality that my biology needs some chemical help. That's just the way it is, and it doesn't make me a weaker or lesser person than anyone else (though I still have moments when I think this - I'll have to work on that in therapy, I suppose.)

Things have been getting better, but we're still trying to get the drug doses right, so it's not like the drugs are a cure-all by any means. I know that I have to continue doing everything else on this list to ensure that my mental health is taken care of. Which brings us to...

Exercise: Yeah, I'm still working on this one. They say that exercise improves pretty much every mental illness. But the problem with mental illness is that you're too exhausted/depressed/anxious to exercise. I mean, if you can't get out of bed in the morning, are you seriously going to go for a jog around the block? I think not! But I'm hoping that the drugs can put me in a good enough place that I can start exercising to stop the cycle of depression.

Does anyone else want to add to the list? How do you cope with depression?

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!