Postoperative continuation of antidepressant therapy is associated with reduced short-term weight loss following Roux-en-Y gastric bypass surgery
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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.
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.
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.
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.
KeywordsGastric bypass Antidepressants Weight loss Surgery outcomes Bariatric surgery
Roux-en-Y gastric bypass
Body mass index (weight/length2)
Percentage excess BMI loss
Percentage total weight loss
Selective serotonin reuptake inhibitor
Serotonin-norepinephrine reuptake inhibitor
Norepinephrine and dopamine reuptake inhibitor
95% confidence interval
The authors thank Maud De Venter for her assistance in the preoperative psychological assessment.
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.
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).
- 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
- 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.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
- 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
- 21.American Psychiatric Association (APA), Practice guideline for the treatment of patients with major depressive disorder - third edition (2010)Google Scholar
- 22.National Institute for Health and Care Excellence (NICE), Depression in adults: recognition and management. (2009 (updated 2018))Google Scholar