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Clinical depression and surgery

Bariatric surgery has limited impact on depression

Credit:Flickr/Airman 1st Class Devin N. Boyer
The proportion of participants prescribed antidepressants began to rise again after the first year and surpassed pre-surgery levels in the fifth year following bariatric surgery
Among participants who were depressed in the pre-operative year, the prevalence of depression was generally close to 75% post-operatively

The results from a large population-based study suggest that bariatric surgery may have only a limited and short-lived effect on clinical depression. The study (‘Impact of bariatric surgery on clinical depression (Interrupted time series study with matched controls’, Journal of Affective Disorders) was published on behalf of the King׳s Bariatric Surgery Study Group led by Professor Martin Guilliford and concluded that randomised studies of the effect of bariatric surgery on depression are required in order to provide much needed data on this subject.

The authors undertook a study to evaluate whether bariatric surgery is associated with a reduction in clinical depression up to seven years following the procedure. This population-based cohort utilised electronic health records from the UK Clinical Practice Research Datalink (CPRD) - a prospectively collected database of primary care electronic health records including demographic, clinical, diagnostic and prescribing information for approximately 6% of the UK population. The patients were evaluated for clinical diagnoses of depression and prescription of anti-depressant drugs in the three years before and the seven years after bariatric surgery. Clinical depression was identified through medical diagnoses for depression recorded in clinical or referral records as well as through prescriptions for anti-depressant drugs.

In total there were 3,045 participants identified as having bariatric surgery for obesity and 3,045 matched controls. These patients were evaluated for clinical diagnoses of depression and prescription of anti-depressant drugs in the three years before, and up to seven years after, bariatric surgery.

Surgical procedures included laparoscopic gastric banding (LAGB) (n=1,297; 43%), gastric bypass (n=1,265; 42%), sleeve gastrectomy (n=477; 16%) and six undefined type. After two years 63% of patients were available for follow-up with 31% available for follow up in the fifth year. In the year prior to surgery, 36% of surgery participants met the criteria for prevalent clinical depression in comparison to 21% of control participants (Figure 1). In the surgery group this figure reduced to 32% in the participants two years following surgery before rising to pre-surgery levels (37%) in the seventh year of follow-up. 

Figure 1: Prevalence of clinical depression for bariatric surgery cases (black) and controls (grey) for three years before and seven years after index date.

Compared with control participants, surgical participants were more likely to be diagnosed with clinical depression (odds ratio 2.02, 95% confidence interval 1.75–2.33, p=0.001) or to be prescribed antidepressant drugs (1.97, 1.72–2.25, p=0.001). There was also a reduction in clinical depression and antidepressant prescribing in the first three years following the procedure and similar changes were observed for the related outcome of antidepressant prescribing. However the proportion of participants prescribed antidepressants began to rise again after the first year and surpassed pre-surgery levels in the fifth year following bariatric surgery. In addition, the type of surgery did not have an impact on depression.

Omar Khan and Marcus Reddy, the two surgical authors of this study commented- “The relationship between obesity, depression and bariatric surgery is highly complex and has been poorly investigated. What the CRPD database allows us to do is examine a large population over time giving us a unique ability to track depression over a long timeframe. These results indicate that bariatric surgery in obese patients may be associated with a modest reduction in the prevalence of depression, and the use of anti-depressant medications in primary care. However patients undergoing surgery may receive a package of supportive care and improved clinical management to prepare them for surgery, which may confound the effect of the surgical procedure. Moreover the beneficial effects of bariatric surgery do not appear to persist more than three years following the procedure. However this study illustrates the need for large scale randomised studies of the effect of bariatric surgery on depression.”

The authors of this study were Helen Booth, Omar Khan, A Toby Prevost, Marcus Reddy, Judith Charlton and Martin C Gulliford, on behalf of the King׳s Bariatric Surgery Study Group that also includes Mark Ashworth, Alex Dregan, Alison Fildes, Peter Littlejohns and Caroline Rudisill.

To access this paper, please click here

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