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Postoperative continuation of antidepressant therapy is associated with reduced short-term weight loss following Roux-en-Y gastric bypass surgery

  • Philip PlaekeEmail author
  • Filip Van Den Eede
  • Ben Gys
  • Anthony Beunis
  • Martin Ruppert
  • Joris De Man
  • Benedicte De Winter
  • Guy Hubens
Original Article
  • 26 Downloads

Abstract

Purpose

Bariatric surgery candidates are frequently treated with antidepressants. Several of these drugs have been associated with weight gain and could potentially interfere with weight loss after bariatric surgery. This cohort study aimed to investigate the short-term effects of antidepressants on weight loss during the first 24 months after a Roux-en-Y gastric bypass.

Methods

Patients with a fully documented antidepressant treatment status for at least 12 months were retrospectively included. Weight loss was expressed as the percentage excess BMI loss (%EBMIL) or percentage total weight loss (%TWL). A mixed linear effects model was used to determine the impact of continued and discontinued treatment with antidepressants on weight loss.

Results

A total of 751 patients were included in this study. At 24 months, patients had lost 77.38 ± 30.10 %EBMIL (30.63 ± 13.12 %TWL). In patients treated with antidepressants (n = 125), the %EBMIL and %TWL was reduced with − 2.81% (p = 0.025) and − 1.36% (p = 0.002) respectively, and with − 5.52 %EBMIL (p < 0.001; − 1.05 %TWL, p = 0.012) after multivariate adjustment. Serotonin-norepinephrine reuptake inhibitors (− 12.47 %EBMIL, p < 0.001) and tricyclic antidepressants (− 11.01 %EBMIL, p = 0.042) were predominantly responsible for worse outcomes. Beyond 24 months, at 36 months (− 4.83%, p < 0.001) and 48 months (− 3.54%, p = 0.006), the %EBMIL was still reduced. No significant effects of antidepressants on metabolic outcomes after surgery were observed.

Conclusions

Treatment with antidepressants was associated with reduced weight loss after gastric bypass surgery, but only if treatment was continued for at least 1 year postoperatively. Mainly tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors were responsible for this reduction in weight loss.

Keywords

Gastric bypass Antidepressants Weight loss Surgery outcomes Bariatric surgery 

Abbreviations

RYGB

Roux-en-Y gastric bypass

BMI

Body mass index (weight/length2)

%EBMIL

Percentage excess BMI loss

%TWL

Percentage total weight loss

SSRI

Selective serotonin reuptake inhibitor

SNRI

Serotonin-norepinephrine reuptake inhibitor

TCA

Tricyclic antidepressant

NDRI

Norepinephrine and dopamine reuptake inhibitor

95%CI

95% confidence interval

SD

Standard deviation

HDL

High-density lipoprotein

Notes

Acknowledgements

The authors thank Maud De Venter for her assistance in the preoperative psychological assessment.

Authors’ contributions

Plaeke P: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Van Den Eede F: study conception and design, interpretation of data, drafting of manuscript, critical revision of manuscript. Gys B: critical revision of manuscript. Beunis A: critical revision of manuscript. Ruppert M: critical revision of manuscript. De Man J: critical revision of manuscript. De Winter B: analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Hubens G: study conception and design, interpretation of data, drafting of manuscript, critical revision of manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Retrospective data collection was approved by the ethical committee of the Antwerp University Hospital (File number 15/48/513).

Supplementary material

423_2019_1784_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)
423_2019_1784_MOESM2_ESM.docx (15 kb)
ESM 2 (DOCX 14 kb)

References

  1. 1.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737CrossRefGoogle Scholar
  2. 2.
    Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122(3):248–256.e245CrossRefGoogle Scholar
  3. 3.
    Still CD, Wood GC, Chu X, Manney C, Strodel W, Petrick A, Gabrielsen J, Mirshahi T, Argyropoulos G, Seiler J, Yung M, Benotti P, Gerhard GS (2014) Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring) 22(3):888–894CrossRefGoogle Scholar
  4. 4.
    Wimmelmann CL, Dela F, Mortensen EL (2014) Psychological predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract 8(4):e299–e313CrossRefGoogle Scholar
  5. 5.
    Kalarchian MA, King WC, Devlin MJ, Marcus MD, Garcia L, Chen JY, Yanovski SZ, Mitchell JE (2016) Psychiatric disorders and weight change in a prospective study of bariatric surgery patients: a 3-year follow-up. Psychosom Med 78(3):373–381CrossRefGoogle Scholar
  6. 6.
    Rutledge T, Groesz LM, Savu M (2011) Psychiatric factors and weight loss patterns following gastric bypass surgery in a veteran population. Obes Surg 21(1):29–35CrossRefGoogle Scholar
  7. 7.
    Rydén A, Torgerson JS (2006) The Swedish Obese Subjects Study—what has been accomplished to date? Surg Obes Relat Dis 2(5):549–560CrossRefGoogle Scholar
  8. 8.
    Dawes AJ, Maggard-Gibbons M, Maher AR, Booth MJ, Miake-Lye I, Beroes JM, Shekelle PG (2016) Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA 315(2):150–163CrossRefGoogle Scholar
  9. 9.
    Mitchell JE, King WC, Chen JY, Devlin MJ, Flum D, Garcia L, Inabet W, Pender JR, Kalarchian MA, Khandelwal S, Marcus MD, Schrope B, Strain G, Wolfe B, Yanovski S (2014) Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity (Silver Spring) 22(8):1799–1806CrossRefGoogle Scholar
  10. 10.
    Gafoor R, Booth HP, Gulliford MC (2018) Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ 361:k1951Google Scholar
  11. 11.
    Serretti A, Mandelli L (2010) Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry 71(10):1259–1272CrossRefGoogle Scholar
  12. 12.
    Zimmermann U, Kraus T, Himmerich H, Schuld A, Pollmächer T (2003) Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res 37(3):193–220CrossRefGoogle Scholar
  13. 13.
    Uguz F, Sahingoz M, Gungor B, Aksoy F, Askin R (2015) Weight gain and associated factors in patients using newer antidepressant drugs. Gen Hosp Psychiatry 37(1):46–48CrossRefGoogle Scholar
  14. 14.
    Love RJ, Love AS, Bower S, Carlos Poston WS (2008) Impact of antidepressant use on gastric bypass surgery patients’ weight loss and health-related quality-of-life outcomes. Psychosomatics 49(6):478–486CrossRefGoogle Scholar
  15. 15.
    Malone M, Alger-Mayer SA, Polimeni JM (2011) Antidepressant drug therapy does not affect weight loss one year after gastric bypass surgery. Obes Surg 21(11):1721–1723CrossRefGoogle Scholar
  16. 16.
    Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JPT, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JPA, Geddes JR (2018) Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 391(10128):1357–1366CrossRefGoogle Scholar
  17. 17.
    Cunningham JL, Merrell CC, Sarr M, Somers KJ, McAlpine D, Reese M, Stevens SR, Clark MM (2012) Investigation of antidepressant medication usage after bariatric surgery. Obes Surg 22(4):530–535CrossRefGoogle Scholar
  18. 18.
    Wysokinski AKI (2014) Mechanisms of increased appetite and weight gain induced by psychotropic medications. J. Adv. Clin. Pharmacol. 1:12–33CrossRefGoogle Scholar
  19. 19.
    Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA (2016) The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: a critical review of the literature. Psychother Psychosom 85(5):270–288CrossRefGoogle Scholar
  20. 20.
    de Jonge L, Petrykiv S, Fennema J, Arts M (2017) The effects of bariatric surgery on pharmacokinetics of antidepressants: a systematic review. Eur Psychiatry 41:S232–S233CrossRefGoogle Scholar
  21. 21.
    American Psychiatric Association (APA), Practice guideline for the treatment of patients with major depressive disorder - third edition (2010)Google Scholar
  22. 22.
    National Institute for Health and Care Excellence (NICE), Depression in adults: recognition and management. (2009 (updated 2018))Google Scholar
  23. 23.
    Ryder JR, Gross AC, Fox CK, Kaizer AM, Rudser KD, Jenkins TM, Ratcliff MB, Kelly AS, Kirk S, Siegel RM, Inge TH (2018) Factors associated with long-term weight loss maintenance following bariatric surgery in adolescents with severe obesity. Int J Obes 42(1):102–107CrossRefGoogle Scholar
  24. 24.
    Wood G, Benotti PN, Lee CJ et al (2016) Evaluation of the association between preoperative clinical factors and long-term weight loss after Roux-en-Y gastric bypass. JAMA Surg 151(11):1056–1062CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Laboratory of Experimental Medicine and Pediatrics (LEMP)University of AntwerpWilrijkBelgium
  2. 2.Department of Abdominal SurgeryAntwerp University HospitalEdegemBelgium
  3. 3.Department of PsychiatryAntwerp University HospitalEdegemBelgium
  4. 4.Collaborative Antwerp Psychiatric Research InstituteUniversity of AntwerpWilrijkBelgium
  5. 5.Antwerp Surgical Training, Anatomy and Research Centre (ASTARC)University of AntwerpWilrijkBelgium

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