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SG and psychiatric medication

Patients report improvements in anxiety and depression after SG

In the noted absence of clinical and medication factors predicting symptom improvement, the data may suggest an independent effect of SG on depression

A majority of patients who had a sleeve gastrectomy (SG) reported an improvement in anxiety and depression, according to a study by researchers from the University at Buffalo. The investigators noted that anti-depressant and anti-anxiety medication regimens were altered in approximately one-third of cases and were primarily dose decrease or discontinuation, and where symptoms improved the medications were decreased or discontinued in over 90%. The paper, ‘Impact of Sleeve Gastrectomy on Psychiatric Medication Use and Symptoms’, was published in the Journal of Obesity.

The study authors noted that an estimated 36% of bariatric surgery patients are diagnosed with depression and 11% with anxiety, and they noted one advantage of SG is believed to be the reduced impacted on altered medication absorption in comparison with RYGB – as the transition to the small intestine remains continuous. Nevertheless, according tot eh authors there are no anti-depressant or anti-anxiety medication absorption and efficacy studies after SG. As a result, they established their study to characterise depression and anxiety symptom change, and anti-depressant and anti-anxiety medication use change, as well as identify predictors of symptom improvement or worsening after SG.

Patients with a diagnosis of depression and/or anxiety and who were treated taking anti-depressants or anti-anxiety medication were included in the study and their symptom changes were recorded overtime (three-six months post-surgery), as well as changes in medication. In total 59, patients were included in the study - 38 with depression, eight with anxiety and 13 with both.

Outcomes

The researchers reported that depression symptoms improved in 34/51 (67%) subjects in the three–six months following SG. They found that age, gender, height, ideal body weight, weight and excess body weight at the time of surgery, and percentage of excess body weight loss after surgery were not significantly associated with symptom change after SG (p>0.1 for all).

In addition, changes in medication use were not significantly associated with symptom change after SG. In 32 case (94%) cases where symptoms improved, medications were discontinued, decreased, or unchanged. Symptoms worsened in four (8%) patients, were unchanged in three (6%) and were mixed in ten (20%).

In patients with anxiety symptoms, there was a noted improvement in 12/21 (57%) patients. Gender, height, ideal body weight, weight and excess body weight at the time of surgery, and percentage of excess body weight loss after surgery were not significantly associated with symptom change after SG (p>0.1 for all), although increased age was predictive of symptom improvement (p=0.041).

Again, changes to medication use were not significantly associated with symptom change after SG. In cases where symptoms improved, 11 (92%) occurred in circumstances where medications were discontinued, decreased, or unchanged. Symptoms worsened in three (14%), were unchanged in one (5%), and were mixed in five (24%).

The authors noted that this study only assessed the initial stages of mental and emotional adjustment to SG and weight loss after surgery and therefore does not provide any outcomes in the long-term. They also said that they did not investigate alternative explanations for improvements in their depression and anxiety symptom such as initial weight loss or sense of relief due to a successful surgery.

“Approximately 10–20% of cases were dose increases or class switches leaving open the possibility of compromised absorption,” the authors conclude. “In depression and anxiety cases where symptoms improved, the medications were decreased or discontinued in over 90%. In the noted absence of clinical and medication factors predicting symptom improvement, these data may suggest an independent effect of SG on depression.”

To access this paper, please click here

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