Depression post-surgery

[sunlioness]

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Hey everyone, just thought I'd run this by you. I recently saw a guy in his early 50s without any significant medical or psychiatric history. He had relatively minor surgery for which he recevied both general and spinal anesthesia. Since this time, he's developed a pretty significant depression. His medical docs/surgeons haven't sent him for any scans, bloodwork or anything like that. And I was wondering if off the top of your collective heads there are any tests you would definitely send this guy for to rule out any untoward medical badness. I can work with the depression; I just don't want to miss anything. And it happening so suddenly after surgery like that in a person with no real history is raising some alarm bells internally.

 

[Doc Samson]

Depends on the surgery to some extent. I would wonder if this simply represents an existential crisis as this 50-something encounters what sounds like his first face-to-face meeting with his own mortality.

 

[sunlioness]

That's actually what I was thinking too. It was a hemmorhoid surgery. And he does have a family history of people responding to acute stressors with depression/anxiety. So I think it is that, I just really don't want to mis anything.

 

[Doc Samson]

If he's cognitively intact (i.e., not suffering lasting sequelae of GETA), then I'd go with your instinct that this is "just" depression. Cognitive slowing can look like depression though - maybe drop a MoCA on him just to be sure?

 

[sunlioness]

That's not a bad idea. Thanks. 🙂 I was thinking of sending him for a CT, but I don't know precisely what I'd be looking for and I don't want to find something that ends up being irrelevant.

 

[Regnvejr]

That's not a bad idea. Thanks. 🙂 I was thinking of sending him for a CT, but I don't know precisely what I'd be looking for and I don't want to find something that ends up being irrelevant.

The gilded rule: "Never test for anything you don't treat." That aside, checking that he didn't throw a lot of small clots might not be a bad idea, but presumably PT & PTT was tester pre-op anyway for just that reason.

But in my experience, a bit of hydroxyzine often settles mild mood from physical stress, as long as it doesn't snow the patient.