Psychopharmacology and Bariatric Surgery

Abstract

Currently, it has been demonstrated that psychotropic drugs, particularly antidepressants, are frequently prescribed for patients who seek bariatric surgery. Many bariatric surgery patients have a history of a mood disorder. Unlike medications for diabetes, hypertension or hyperlipidemia, which are generally reduced and at times discontinued, postsurgery antidepressants use is only slightly reduced. The Roux-en-Y procedure is most frequently associated with alteration in drug exposure. Medication disintegration, dissolution, absorption, metabolism and excretion have been found to be altered in postbariatric patients, although data are sparse at this time. This paper will review the current evidence regarding the effect of bariatric surgery on drug treatment including mechanism of interference as well as the extent of changes identified to date. Data will be presented as controlled trials followed by case series and reports.

Surgical Management of Obesity Among People with Schizophrenia and Bipolar Disorder: a Systematic Review of Outcomes and Recommendations for Future Research

“…Literature regarding psychotropic pharmacokinetic changes in bariatric surgery patients is sparse [18]. Weight loss, nutritional status and short-term complications such as vomiting, diarrhoea and dehydration may induce changes in drug absorption, metabolism and response variability.…”

“…Thus, close psychiatric monitoring, individual dose-adjustment and therapeutic monitoring (blood level of drug) are highly recommended. Rigorously conducted controlled studies are needed to evaluate the effect of bariatric procedures on pharmacokinetic changes of psychotropic medication and other high-risk medications [18]. Finally, given the high risk of alcohol abuse/dependence and other addictive disorders following bariatric surgery, a referral to a specialist in addiction medicine should be also proposed [42,43].…”

“…This may in part be due to concerns about ability to adhere to the lifestyle changes required and whether that might impact effectiveness and safety, but there is little evidence to corroborate such assumptions. In addition, the risk of malabsorption of pharmacological treatment after surgery is an important limit and very few studies focused on psychotropic drugs monitoring after surgery [18]. In this paper, we conducted a systematic review to summarize the available knowledge on bariatric surgery in people with schizophrenia or BD, including information on the outcomes and safety of these procedures.…”

Aggressive clinical approach to obesity improves metabolic and clinical outcomes and can prevent bariatric surgery: a single center experience

“…Historically, anti-obesity pharmacotherapy has been improperly managed due to (a) the too short-term drug prescriptions [ 16 , 28 , 29 , 48 ], (b) lack of weight maintenance follow-up [ 16 , 27 , 29 , 49 , 50 ], (c) lack of pharmacological combinations [ 16 – 18 , 30 ], and (d) undertreatment [ 16 , 51 ], since only 2% of patients with obesity are prescribed pharmacological treatments [ 51 ]. Obesity involves multiple central and peripheral mechanisms to prevent weight loss and induce weight regain after a period of weight loss, such as decreased resting metabolic rate and enhanced food-reward circuit sensitivity [ 16 , 27 , 29 , 49 ].…”

“…(4) There is a lack of weight-loss maintenance strategies, although some studies have proposed successful approaches to prevent weight regain [ 27 , 29 ]. (5) The complex pathophysiology [ 27 , 30 ] of obesity and its multiple etiologies that are present in every patient are frequently misunderstood. Such an understanding is critical to provide psychological support [ 12 , 31 ] allied to intensive lifestyle modification [ 26 ], and its lack has arguably led to a decline in diet, physical activity and weight counseling [ 15 ].…”