Illinois Democratic Rep. Jesse Jackson Jr., who is undergoing treatment for bipolar II depression, may have had struggled with mood issues even before 2004 gastric bypass surgery, according to medical experts.
But they dismissed speculation that the common procedure for weight loss could have played a role in his diagnosis. Rather, they say that it is more likely the procedure might have exacerbated depressive thoughts that were already in place.
Neither doctor, one a gastric bypass specialist, the other a psychiatrist with an expertise in bipolar disorder, has treated Jackson Jr..
After months of secrecy about what was ailing Jackson Jr., The Mayo Clinic this week announced that he was suffering from a milder form of bipolar disorder, "most likely caused by a complex set of genetic and environmental factors."
His wife Sandi has said that Jackson's depression might have been connected to the bypass procedure.
"I never really wanted him to have the gastric surgery in the first place," she told the Chicago Sun-Times. The congressman had a DS or duodenal switch, recommended for those with a BMI over 40.
Jackson Jr., who is 5-feet, 9-inches tall, reportedly weighed 220 when he entered Congress in 1995, but ballooned to 260 pounds, according to the online lifestyle magazine Jet.
"I had been on every conceivable diet," he reportedly told Jet. "I worked out twice a day with martial arts. Much of what constitutes a correct lifestyle I had been living. I'd been working on eating correctly. Nothing was translating into weight loss. As a matter of fact, I was getting bigger. The more I worked out. The bigger I got."
Jackson Jr., 47, has been on a leave of absence from Congress since June 10, and his office initially said that he was being treated for "exhaustion," but did not say where. In July, they said he had been evaluated for depression at the Mayo Clinic.
His wife said he had collapsed in his home days before being taken to the hospital, but he did not attempt suicide and was not being treated for drug or alcohol addiction.
"Jesse told his father he was so exhausted, he couldn't take another step," Sandi Jackson told the Chicago Sun-Times. "I was in Chicago, when Jesse -- who was at home in Washington, D.C., collapsed. His father, Rev. Jackson, called him on the phone and felt he didn't sound right."
Except for a higher incidence of depression, those who are obese are no more likely to have severe mental health issues than those who are not, according to Dr. Mitchell Roslin, a bariatric surgeon at Lenox Hill Hospital in New York.
"That being said, clinically I have seen people with bipolar disorder or cyclothymia go through manic episodes following surgery," said Roslin. "This can be seen with shopping sprees, divorces, high-risk sexual escapades and other behaviors. Rather than cause, the weight loss unmasks the psychological illness that was long standing and probably more expressed by the depressed side, more than the manic side."
However, bypass surgery can change absorption of medications, and patients on mood stabilizers need to be monitored carefully, according to Roslin.
Bipolar disorder can cause dramatic mood swings from highs to lows.
In Jackson Jr.'s case, he was diagnosed with bipolar disorder II, which differs from bipolar I only on the severity of the manic side, according to Dr. Igor Galynker, director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in New York City.
In bipolar I, the manic symptoms can include lack of sleep, sexual indiscretions, spending money and having an unrealistic image of the self.
But in bipolar II, people are often "quite successful" for a period of time and may not be hospitalized, according to Galynker. There may be short periods of being hypermanic alternating with deep depression.
"But the down swing is the same and people spend more time depressed than manic," he said.
Eating habits do change in people with bipolar disorder and they may binge eat and gain weight. "It's conceivable somebody, in addition, that a person like that who is on meds could gain a lot of weight," said Galynker.
Bipolar Medications Can Cause Weight Gain
Medications like Seroquil, used for depression, can increase appetite. "It makes people feel like they are pregnant and it is impossible for them to stop eating. People can gain 50 percent of their body weight."
"Pardoxically, it can worsen the condition," said Galynker.
Those with bipolar disorder prior to bypass surgery also have a high incidence of wound reinfection, according to studies.
"The explanation may be that people with bipolar are not as good at taking care of their wounds or keeping it clean or complying with the regimen," said Galynker. "People with bipolar disorder seem to be distractable and have cognition problems, depending on the degree."
Sometimes bypass surgery, like plastic surgery, can make people "more depressed," he said, especially when patients have "unrealistic expectations" about the results.
"For example, somebody may have been told they couldn't be promoted because of their body image, and then they do the bariatric surgery and lose weight and then gain it again ... They went to all the expense and suffering and things didn't change that much. It's easy to imagine they would be depressed."
Jackson Jr. and others with bipolar disorder are most likely to do better in his recovery with the support of family and friends, according to Galykner.
Already, former Rep. Patrick Kennedy has expressed an interest in visiting Jackson, according to ABC's affiliate in Chicago, WLS-TV. Kennedy was also diagnosed with bipolar disorder, but has since resigned from Congress.
Jackson Jr. won a race against former Rep. Debbie Halvorson earlier this year and was predicted to win a ninth term in November, when he is up for reelection.
Having a bipolar II diagnosis should not stand in the way, according to psychiatrist Galynker, as long as the patient is being treated and on the right medications.
"For all intents and purposes they can be healthy and function well," he said.
As for Jackson's wife's reported concern over his condition, "That's a good thing," according to Galynker.
"Our research shows that patients whose families are anxious do better than those who are not anxious," he said. "The family is concerned and that makes them watch over the patient and provide support. When families aren't worried, they don't do so well."