Anxiety, Depression and Gastric Bypass

Gastric bypass may change the way depression and anxiety medications work for a short time

(RxWiki News) Gastric bypass may change the way the body processes selective serotonin reuptake inhibitors (SSRI). This change in processing may result in returning anxiety and depression symptoms in the first month after gastric bypass.

The change in digestion after gastric bypass was linked to a change in the amounts of SSRI available in the blood, which may mean that less drug is available to help with symptoms of anxiety and depression.

A recent study showed that some patients had a decreased amount of available drug in the blood and that this was linked to an increase in anxiety and depression symptoms during the first month after gastric bypass surgery.

"Discuss your gastric bypass surgery with your psychiatrist"

Researchers, led by Giselle G. Hamad, M.D. at the University of Pittsburgh, looked at the way SSRIs were processed by the body before and after gastric bypass surgery and how this related to the drug’s effect on mood. 

Patients in this study were already taking a SSRI for depression or anxiety, and their mood symptoms and blood samples were measured at one month, six months, and 12 months after gastric bypass surgery.

At one month after gastric bypass surgery, they found that about 67% of patients had blood levels of their SSRI that were reduced by about half of the pre-surgery levels. This means that only about half of the pre-surgery amount of drug was available in the blood stream for reducing depression and anxiety symptoms.

Most of the patients showed a return to pre-surgery levels of available drug by the six month mark.

These changes in blood levels of SSRI's were associated with increased depression and anxiety symptoms, which means that the lower blood levels may be affecting the drug’s ability to treat these symptoms. Dr. Hamad and his co-authors recommend that psychiatric symptoms should be closely monitored after gastric bypass surgery.

This was a small study with only 12 participants, so these findings may not be true for all people. The study was published in the March issue of the American Journal of Psychiatry.

Dr. McCloskey reports linkages to Allergan. Dr. Perel served as an expert witness on atomoxetine in the treatment of ADHD for a consortium of pharmaceutical companies. Dr. Wisner has served on an advisory board, with pay, for Eli Lilly and has received study material donations from Novartis.

The other authors report no financial relationships with commercial interests.

This research was supported by the American Society for Metabolic and Bariatric Surgery, the NIH National Center for Research Resources, General Clinical Research Centers, and a Clinical and Translational Science Award grant.

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Review Date: 
April 7, 2012