Increased risk for major depressive disorder in severely obese patients after bariatric surgery — a 12-year nationwide cohort study

Abstract

Bariatric surgery was significantly associated with an elevated risk of MDD. KEY MESSAGES Bariatric surgery is associated with a significant improvement in depressive mood in the initial postoperative years, but the improvement is not maintained. Less is known about the relationship between bariatric surgery and risk of major depressive disorder. This was the first nationwide cohort study which found that bariatric surgery was significantly associated with an elevated risk of MDD (aHR: 1.70; CI: 1.27-2.27), mainly with malabsorptive procedures (aHR: 3.01; CI: 1.78-5.09) and at time points more than four years after surgery (aHR: 2.92; CI: 1.75-4.88) compared with the risk in matched controls. These findings imply an association between long-term malabsorption and the postoperative incidence of MDD. Long-term malabsorption might be related to the incidence of major depressive disorder after bariatric surgery. The possible causal relationship between nutritional deficiency after bariatric surgery and major depressive disorder warrants further investigation.

The impact of bariatric surgery on serum tryptophan–kynurenine pathway metabolites

“…This growing body of research has led to the proposal of the hypothesis that changes in GI tract metabolism, associated with the TRP-KYN pathway, may influence psychological states 51 . As bariatric surgery reduces serum tryptophan, kynurenines and other macronutrient levels, it remains to be seen as to whether this effect may have an impact on the increased incidence of depression after bariatric surgery 52 and warrants further investigation.…”

The Impact of Bariatric Surgery on Serum Tryptophan-Kynurenine Pathway Metabolites

“…This growing body of research has led to the proposal of the hypothesis that changes in GI tract metabolism associated with the TRP-KYN pathway may in uence psychological states [48]. As bariatric surgery reduces tryptophan, kynurenines and other macronutrient levels, it remains to be seen as to whether this effect may have an impact on the increased incidence of depression after bariatric surgery [49] and also warrants further investigation.…”

Metabolic surgery in China: present and future

“…Some patients have mental and nervous system effects after metabolic surgery, such as mild or severe depression. Lu et al (2018) explored the association between metabolic surgery and major depressive disorder in a 12-year nationwide cohort study. Metabolic surgery was significantly associated with a 70% increase in the risk of major depressive disorder, mainly with malabsorptive procedures and >4 years after surgery, compared with the risk in matched controls.…”

“…Metabolic surgery was significantly associated with a 70% increase in the risk of major depressive disorder, mainly with malabsorptive procedures and >4 years after surgery, compared with the risk in matched controls. Long-term malabsorption might be related to the incidence of major depressive disorder after metabolic surgery ( Lu et al, 2018 ). Rare adverse reactions include Wernicke encephalopathy with concurrent polyradiculoneuropathy ( Chang et al, 2019 ).…”