Dear R.C.,

We all know many of the symptoms of depression: sad mood, loss of interest or pleasure in most activities, changes in sleep or appetite, fatigue, recurrent thoughts of death, feelings of worthlessness, etc.  When faced with a major medical event, it can be easy to attribute the cause of these symptoms to the medical problem and dismiss the importance of addressing them on their own.  Who doesn’t have recurrent thoughts of death surrounding a major surgery?  Who doesn’t have trouble sleeping when they have significant pain?  Who doesn’t lose interest and pleasure in activities when they are confined to bed?

The fact is that depression is a very real problem in bypass patients.  Almost half become clinically depressed, with the highest rate of onset occurring within the first two months after surgery. We believe that there are several contributing factors to this problem.  They include the issue of having to face, often for the first time, our struggle with aging and our own mortality.  Also, bypass patients initially experience a great deal of physical debilitation and dependency. With swift discharge from the hospital being relatively standard these days, it becomes the job of loved ones to administer some nursing care at home. Many of us are unaccustomed to relying on others for help with our basic functions and activities of daily living—and we don’t like it one bit.  In addition to the pain and physical limitations imposed by recovery, most patients are under “orders” to make changes in diet, exercise, and other areas.  It is no fun when these are drastic departures from how we are used to living. Your husband’s doctor is likely very alert to the issue of depression, but he or she needs your husband’s and your input and full participation to correctly diagnose and address the issue.  Unfortunately, many patients, especially men, are reluctant to talk about their feelings with a stranger.  Let me help you motivate him.  While he is confined to bed, pop in a tape of the manliest of men, Tony Soprano, with his therapist.  Then, when he has been softened up, sit down and have a serious talk with him.

Start by telling him how much you love him and how much seeing him be worried worries you.  Then let him know that suffering from depression has been linked to a significantly higher rate of ongoing cardiac problems and a higher risk of death.  This may seem like a particularly sticky topic in light of his family history, but you can cushion it by letting him know that he has more control than he may feel.  Following all of his doctor’s recommendations is a given, but he can actively fight against being depressed if he can bring himself to talk about it.  Talking about his feelings is doing something and it is an important something.  I suggest he gives serious thought to including a qualified therapist as part of his recovery team.

It may be helpful for him to know that what he is feeling is not unusual.  According to the American Heart Association, there are a cluster of thoughts and feelings that are common among bypass patients.  One is a fear of dying.  That one is pretty easy to understand.  Another is a fear of chest pains.  Think about it: after a major coronary event, every bout of indigestion or gas could feel like the onset of another heart attack.  Every irregular heartbeat the patient thinks he detects is cause for concern.  The patient is afraid, but he may also be afraid of others thinking he is overreacting. 

Many patients are afraid that they will not be able to have a sex life.  What is more depressing than that?  Your physician should give you a protocol for when to resume normal sexual activity. Remember the movie in which Jack Nicholson is told that he can have sex again when he is able to climb a flight of stairs?  It is a comical scene about a serious and frightening topic.  Most patients do fine; worrying about it may only make matters worse.  Follow your doctor’s advice, and try to relax.

Some patients are faced with having to make drastic adjustments in their work habits.  For many, work represents their very sense of identity.  If big changes are in store, a therapist should be able to help with the transition and to help the patient realize how full their life is, even with a change or reduction in duties.

It is important for both you and your husband to realize that neither of you is responsible for the situation you are in now.  You certainly are not accountable for how the other person chooses to cope with what you now face.  You absolutely can help each other by providing reassurance and love, but you cannot take on the responsibility for another person’s stress.  It can be hard to accept that you may not be able to provide each other with every single thing you may need, but it is indeed a loving act to seek help from outside sources if that if what is warranted. One of the most important elements that a therapist can bring to the table is that he or she is impartial and nonjudgmental. Your therapist is perhaps the only person in your life that you don’t have to protect in any way from what you think or feel.  Because he or she is not a part of your family or social circle, your therapist will not have a particular need for you to not be sad or to not be angry.  It is of primary importance for any individual struggling with depression to not have to keep those feelings inside.