Depression may not be readily apparent to a patient_s family or surgeon. It is difficult to separate depression from the orthopedic condition since the former can unquestionably complicate or obstruct the treatment of the latter. Depressed patients do not full cooperate with therapies and when not in a doctor_s office, they are sleeping, eating or watching television; thereby, gaining weight and increasingly de-conditioned.
Depression is very often presented as irritability, and as a result, the surgeon may find the patient merely unpleasant and noncompliant. The surgeon may recommend that the patient lose weight since weight gain can complicate their recovery. However, the patient compulsively eats as a marker of their depression and as a means of attempting to offset their dysphoria with the pleasure of eating.
The pre-surgical patient is told to quit smoking and knows he/she should do so but depression patients are less likely to successfully quit smoking.
Rehabilitation also involves intense future planning since career alterations resultant from injury are not uncommon. However, a depression individual avoids thoughts of the future, avoids future planning. He/she avoids dealing with the immediate consequences of the injury upon their lives, thinking exclusively in terms of pain and financial losses rather than mobilizing for that future.
We are finalizing next year_s seminar which deals with pain and depression and the recent findings that almost two-thirds of injured workers have symptoms rising to the diagnosis of mood and/or anxiety disorder.