Preprint / Version 1

Elucidating a correlation between general anesthesia and post-operative depression

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  • Ariana Dena San Gabriel High School

DOI:

https://doi.org/10.58445/rars.4270

Keywords:

general anesthesia, Post-Operative Depression (POD), Major Depressive Disorder (MDD)

Abstract

Post-operative depression is a condition in which a person develops new or worsening depressive symptoms after undergoing surgery. Depression is characterized by persistent feelings of sadness, loss of interest in previously enjoyed activities, changes in sleep or appetite, fatigue, difficulty concentrating, and feelings of hopelessness. When these symptoms persist and interfere with daily functioning, they can affect a person's recovery and overall quality of life. Although the underlying causes of post-operative depression are not fully understood, several factors may contribute to its development, including the physiological stress of surgery, pain, and medications administered during the surgical process (Borsook et al., 2010). One factor of particular interest is general anesthesia, as it produces significant changes in brain activity and may influence physiological pathways associated with depression. Here, we examine the potential relationship between general anesthesia and post-operative depression by exploring how different anesthetic agents may influence neurotransmitter activity, inflammation, neuroimmune signaling, and neural pathways involved in mood regulation. We also consider how factors such as age, type of surgery, and anesthetic type may influence post-operative depressive symptoms and patient outcomes. Understanding this relationship may help identify potential risk factors for post-operative depression and guide future research into strategies that support patients' mental health and recovery following surgery.

References

Alhayyan, A., McSorley, S. T., Roxburgh, C., Kearns, R., Horgan, P., & McMillan, D. (2020). The effect of anesthesia on the postoperative systemic inflammatory response in patients undergoing surgery: A systematic review and meta-analysis. Surgery Open Science, 2(1), 1–21. https://doi.org/10.1016/j.sopen.2019.06.001

Bao, Y., et al. (2023). Understanding the neural mechanisms of general anesthesia from interaction with sleep–wake state: A decade of discovery. Pharmacological Reviews. https://doi.org/10.1124/pharmrev.122.000717

Beurel, E., Toups, M., & Nemeroff, C. B. (2020). The bidirectional relationship of depression and inflammation: Double trouble. Neuron, 107(2), 234–256. https://doi.org/10.1016/j.neuron.2020.06.002

Besnier, E., Clavier, T., & Compere, V. (2017). The hypothalamic-pituitary-adrenal axis and anesthetics: A review. Anesthesia & Analgesia, 124(4), 1181–1189. https://doi.org/10.1213/ANE.0000000000001580

Borsook, D., George, E., Kussman, B., & Becerra, L. (2010). Anesthesia and perioperative stress: Consequences on neural networks and postoperative behaviors. Progress in Neurobiology, 92(4), 601–612. https://doi.org/10.1016/j.pneurobio.2010.08.006

Cremeans-Smith, J. K., Soehlen, S., Greene, K., Alexander, T., & Delahanty, D. L. (2009). In-hospital levels of C-reactive protein and IL-6 predict post-operative depressive symptoms among patients undergoing total knee replacement surgery. Brain, Behavior, and Immunity, 23(8), 1096–1103. https://doi.org/10.1016/j.bbi.2009.06.148

Hollmann, M. W., Liu, H. T., Hoenemann, C. W., Liu, W. H., & Durieux, M. E. (2001). Modulation of NMDA receptor function by ketamine and magnesium. Part II: Interactions with volatile anesthetics. Anesthesia & Analgesia, 92(5), 1182–1191. https://doi.org/10.1097/00000539-200105000-00020

Jarkas, D. A., Villeneuve, A. H., Daneshmend, A. Z. B., Villeneuve, P. J., & McQuaid, R. J. (2024). Sex differences in the inflammation-depression link: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 121, 257–268. https://doi.org/10.1016/j.bbi.2024.07.037

Kato, T. A., Yamauchi, Y., Horikawa, H., Monji, A., Mizoguchi, Y., Seki, Y., Hayakawa, K., Utsumi, H., & Kanba, S. (2013). Neurotransmitters, psychotropic drugs and microglia: Clinical implications for psychiatry. Current Medicinal Chemistry, 20(3), 331–344. https://doi.org/10.2174/0929867311320030003

Kira, T., Harata, N., Sakata, T., & Akaike, N. (1998). Kinetics of sevoflurane action on GABA- and glycine-induced currents in acutely dissociated rat hippocampal neurons. Neuroscience, 85(2), 383–394. https://doi.org/10.1016/S0306-4522(97)00637-4

Lee, S., Xue, Y., Petricca, J., Kremic, L., Xiao, M. Z. X., Pivetta, B., Ladha, K. S., Wijeysundera, D. N., & Diep, C. (2024). The impact of pre-operative depression on pain outcomes after major surgery: A systematic review and meta-analysis. Anaesthesia, 79(4), 423–434. https://doi.org/10.1111/anae.16188

Liu, X., Li, Y., Kang, L., & Wang, Q. (2021). Recent advances in the clinical value and potential of dexmedetomidine. Journal of Inflammation Research, 14, 7507–7527. https://doi.org/10.2147/JIR.S346089

Miller, A. H., Maletic, V., & Raison, C. L. (2009). Inflammation and its discontents: The role of cytokines in the pathophysiology of major depression. Biological Psychiatry, 65(9), 732–741. https://doi.org/10.1016/j.biopsych.2008.11.029

Osimo, E. F., Pillinger, T., Rodriguez, I. M., Khandaker, G. M., Pariante, C. M., & Howes, O. D. (2020). Inflammatory markers in depression: A meta-analysis of mean differences and variability in 5,166 patients and 5,083 controls. Brain, Behavior, and Immunity, 87, 901–909. https://doi.org/10.1016/j.bbi.2020.02.010

Sperner-Unterweger, B., Kohl, C., & Fuchs, D. (2014). Immune changes and neurotransmitters: Possible interactions in depression? Progress in Neuro-Psychopharmacology & Biological Psychiatry, 48, 268–276. https://doi.org/10.1016/j.pnpbp.2012.10.006

Stevens, J. L., Feelisch, M., & Martin, D. S. (2019). Perioperative oxidative stress: The unseen enemy. Anesthesia & Analgesia, 129(6), 1749–1760. https://doi.org/10.1213/ANE.0000000000004455

Subramaniyan, S., & Terrando, N. (2019). Neuroinflammation and perioperative neurocognitive disorders. Anesthesia & Analgesia. PMID: 30883423.

Tang, P., & Eckenhoff, R. (2018). Recent progress in the molecular pharmacology of propofol. F1000Research, 7, 123. https://doi.org/10.12688/f1000research.12502.1

Vadivelu, N., Schermer, E., Kodumudi, V., Belani, K., Urman, R. D., & Kaye, A. D. (2016). Role of ketamine for analgesia in adults and children. Journal of Anaesthesiology Clinical Pharmacology, 32(3), 298–306. https://doi.org/10.4103/0970-9185.168149

Wang, H., He, Y., Sun, Z., Ren, S., Liu, M., Wang, G., & Yang, J. (2022). Microglia in depression: An overview of microglia in the pathogenesis and treatment of depression. Journal of Neuroinflammation, 19(1), 132. https://doi.org/10.1186/s12974-022-02492-0

Yang, Y., Hang, W., Li, J., Liu, T., Hu, Y., Fang, F., Yan, D., McQuillan, P. M., Wang, M., & Hu, Z. (2024). Effect of general anesthetic agents on microglia. Aging and Disease, 15(3), 1308–1328. https://doi.org/10.14336/AD.2023.1108

Zhang, M., & Yin, Y. (2023). Dual roles of anesthetics in postoperative cognitive dysfunction: Regulation of microglial activation through inflammatory signaling pathways. Frontiers in Immunology, 14, 1102312. https://doi.org/10.3389/fimmu.2023.1102312

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2026-10-15