The Impact of Bariatric Surgery on Depression: a Review

  • Noah J. Switzer
  • Estifanos Debru
  • Neal Church
  • Philip Mitchell
  • Richdeep Gill
Obesity + Diet (G. Rao, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Obesity and Diet


More than half of patients with obesity who present for medical or surgical management meet the criteria for a psychiatric illness, commonly a mood disorder. Bariatric surgery leads to significant improvement in depression symptomology and a reduction in the overall prevalence of depression. Studies generally report short-term overall reduction in depression rates between approximately 55 to 65 % within the first two years following surgery. It appears that there is a dose response relationship between weight loss and resolution of depression. There are some conflicting reports in the literature as to the maintenance of depression outcomes following bariatric surgery, with newer, long-term studies reporting the attenuation of depression symptomology improvements. While generally, bariatric surgery is beneficial for depression, there exists a cohort of patients who might actually worsen following surgery. A likely multifactorial consequence of weight regain, unrealistic expectations or other life stresses, this group needs to be monitored closely, as postoperative bariatric surgery patients surgery appear to be at an increased risk of suicide. Overall, a multidisciplinary team including psychiatrists, psychologists and other mental health professionals are vital to optimize patient care in the depressed, obese bariatric surgery patient.


Bariatric surgery Depression Obesity Review 


Compliance with Ethical Standards

Conflicts of Interests

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.•
    Mitchell JE, King WC, Chen JY, Devlin MJ, Flum D, Garcia L, et al. Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity. 2014;22(8):1799–806. doi: 10.1002/oby.20738. This is an observational study on a large cohort of US patients, describing the pre-operative incidence of depression in the bariatric patient and the effect of bariatric surgery on this outcome, up to 3 years postoperatively. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Higgs ML, Wade T, Cescato M, Atchison M, Slavotinek A, Higgins B. Differences between treatment seekers in an obese population: medical intervention vs. dietary restriction. J Behav Med. 1997;20(4):391–405.CrossRefPubMedGoogle Scholar
  3. 3.
    Roberts RE, Kaplan GA, Shema SJ, Strawbridge WJ. Are the obese at greater risk for depression? Am J Epidemiol. 2000;152(2):163–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Green DD, Engel SG, Mitchell JE. Psychological aspects of bariatric surgery. Curr Opin Psychiatry. 2014;27(6):448–52. doi: 10.1097/YCO.0000000000000101.CrossRefPubMedGoogle Scholar
  5. 5.
    Ryden A, Torgerson JS. The Swedish Obese Subjects Study—what has been accomplished to date? Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2006;2(5):549–60. doi: 10.1016/j.soard.2006.07.006.CrossRefGoogle Scholar
  6. 6.••
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA : J Am Med Assoc. 2004;292(14):1724–37. doi: 10.1001/jama.292.14.1724. This reference is of particular importance to any study in bariatric surgery since this is the most well cited review on the outcomes of bariatric surgery. CrossRefGoogle Scholar
  7. 7.•
    Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–9. doi: 10.1001/archgenpsychiatry.2010.2. This reference is important as it establishes and explains the bidirectional relationship between obesity and depression. CrossRefPubMedGoogle Scholar
  8. 8.
    Mansur RB, Brietzke E, McIntyre RS. Is there a “metabolic-mood syndrome”? A review of the relationship between obesity and mood disorders. Neurosci Biobehav Rev. 2015;52:89–104. doi: 10.1016/j.neubiorev.2014.12.017.CrossRefPubMedGoogle Scholar
  9. 9.
    Bjorntorp P. Do stress reactions cause abdominal obesity and comorbidities? Obesity reviews: an official journal of the International Association for the Study of Obesity. 2001;2(2):73–86.CrossRefGoogle Scholar
  10. 10.
    Onyike CU, Crum RM, Lee HB, Lyketsos CG, Eaton WW. Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2003;158(12):1139–47.CrossRefPubMedGoogle Scholar
  11. 11.
    Jones-Corneille L, Wadden T, Sarwer D. Risk of depression and suicide in patients with extreme obesity who seek bariatric surgery. Obes Manag. 2007;3(6):255–60.CrossRefGoogle Scholar
  12. 12.
    Hubbard VS, Hall WH. Gastrointestinal surgery for severe obesity. Obes Surg. 1991;1(3):257–65.CrossRefPubMedGoogle Scholar
  13. 13.
    Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, Azarbad L, Ryee MY, Woodson M, et al. Psychosocial evaluation of bariatric surgery candidates: a survey of present practices. Psychosom Med. 2005;67(5):825–32. doi: 10.1097/01.psy.0000174173.32271.01.CrossRefPubMedGoogle Scholar
  14. 14.
    Herpertz S, Kielmann R, Wolf AM, Hebebrand J, Senf W. Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. Obes Res. 2004;12(10):1554–69. doi: 10.1038/oby.2004.195.CrossRefPubMedGoogle Scholar
  15. 15.
    Cassin S, Sockalingam S, Hawa R, Wnuk S, Royal S, Taube-Schiff M, et al. Psychometric properties of the Patient Health Questionnaire (PHQ-9) as a depression screening tool for bariatric surgery candidates. Psychosomatics. 2013;54(4):352–8. doi: 10.1016/j.psym.2012.08.010.CrossRefPubMedGoogle Scholar
  16. 16.
    Kalarchian MA, Marcus MD, Levine MD, Soulakova JN, Courcoulas AP, Wisinski MS. Relationship of psychiatric disorders to 6-month outcomes after gastric bypass. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2008;4(4):544–9. doi: 10.1016/j.soard.2008.03.003.CrossRefGoogle Scholar
  17. 17.
    Powers PS, Rosemurgy A, Boyd F, Perez A. Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction. Obes Surg. 1997;7(6):471–7. doi: 10.1381/096089297765555197.CrossRefPubMedGoogle Scholar
  18. 18.
    Semanscin-Doerr DA, Windover A, Ashton K, Heinberg LJ. Mood disorders in laparoscopic sleeve gastrectomy patients: does it affect early weight loss? Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2010;6(2):191–6. doi: 10.1016/j.soard.2009.11.017.CrossRefGoogle Scholar
  19. 19.
    Fuchs HF, Laughter V, Harnsberger CR, Broderick RC, Berducci M, DuCoin C, et al. Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success. Surg Endosc. 2015. doi: 10.1007/s00464-015-4196-8.Google Scholar
  20. 20.
    Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1):70–89. doi: 10.1007/s11695-011-0472-4.CrossRefPubMedGoogle Scholar
  21. 21.
    Sheets CS, Peat CM, Berg KC, White EK, Bocchieri-Ricciardi L, Chen EY, et al. Post-operative psychosocial predictors of outcome in bariatric surgery. Obes Surg. 2015;25(2):330–45. doi: 10.1007/s11695-014-1490-9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Fabricatore AN, Sarwer DB, Wadden TA, Combs CJ, Krasucki JL. Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery. Obes Surg. 2007;17(9):1213–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Da Silva VB, Da Silva RB, Azorin JM, Belzeaux R. Mood disorders are highly prevalent but underdiagnosed among patients seeking bariatric surgery. Obes Surg. 2015;25(3):543–4. doi: 10.1007/s11695-014-1557-7.CrossRefPubMedGoogle Scholar
  24. 24.
    Duarte-Guerra LS, Coelho BM, Santo MA, Wang YP. Psychiatric disorders among obese patients seeking bariatric surgery: results of structured clinical interviews. Obes Surg. 2015;25(5):830–7. doi: 10.1007/s11695-014-1464-y.CrossRefPubMedGoogle Scholar
  25. 25.
    Ambwani S, Boeka AG, Brown JD, Byrne TK, Budak AR, Sarwer DB, et al. Socially desirable responding by bariatric surgery candidates during psychological assessment. Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 2013;9(2):300–5. doi: 10.1016/j.soard.2011.06.019.CrossRefGoogle Scholar
  26. 26.
    Burgmer R, Legenbauer T, Muller A, de Zwaan M, Fischer C, Herpertz S. Psychological outcome 4 years after restrictive bariatric surgery. Obes Surg. 2014;24(10):1670–8. doi: 10.1007/s11695-014-1226-x.CrossRefPubMedGoogle Scholar
  27. 27.
    Hayes S, Stoeckel N, Napolitano MA, Collins C, Wood GC, Seiler J, et al. Examination of the Beck Depression inventory-II factor structure among bariatric surgery candidates. Obes Surg. 2015;25(7):1155–60. doi: 10.1007/s11695-014-1506-5.CrossRefPubMedGoogle Scholar
  28. 28.
    Emery CF, Fondow MD, Schneider CM, Christofi FL, Hunt C, Busby AK, et al. Gastric bypass surgery is associated with reduced inflammation and less depression: a preliminary investigation. Obes Surg. 2007;17(6):759–63.CrossRefPubMedGoogle Scholar
  29. 29.
    Burgmer R, Petersen I, Burgmer M, de Zwaan M, Wolf AM, Herpertz S. Psychological outcome two years after restrictive bariatric surgery. Obes Surg. 2007;17(6):785–91.CrossRefPubMedGoogle Scholar
  30. 30.
    de Zwaan M, Enderle J, Wagner S, Muhlhans B, Ditzen B, Gefeller O, et al. Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord. 2011;133(1–2):61–8. doi: 10.1016/j.jad.2011.03.025.CrossRefPubMedGoogle Scholar
  31. 31.
    Hayden MJ, Dixon JB, Dixon ME, Shea TL, O'Brien PE. Characterization of the improvement in depressive symptoms following bariatric surgery. Obes Surg. 2011;21(3):328–35. doi: 10.1007/s11695-010-0215-y.CrossRefPubMedGoogle Scholar
  32. 32.
    Sears D, Fillmore G, Bui M, Rodriguez J. Evaluation of gastric bypass patients 1 year after surgery: changes in quality of life and obesity-related conditions. Obes Surg. 2008;18(12):1522–5. doi: 10.1007/s11695-008-9604-x.CrossRefPubMedGoogle Scholar
  33. 33.
    Nijamkin MP, Campa A, Sosa J, Baum M, Himburg S, Johnson P. Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial. J Acad Nutr Diet. 2012;112(3):382–90. doi: 10.1016/j.jada.2011.10.023.CrossRefPubMedGoogle Scholar
  34. 34.
    McGuire MT, Wing RR, Klem ML, Lang W, Hill JO. What predicts weight regain in a group of successful weight losers? J Consult Clin Psychol. 1999;67(2):177–85.CrossRefPubMedGoogle Scholar
  35. 35.
    Orth WS, Madan AK, Taddeucci RJ, Coday M, Tichansky DS. Support group meeting attendance is associated with better weight loss. Obes Surg. 2008;18(4):391–4. doi: 10.1007/s11695-008-9444-8.CrossRefPubMedGoogle Scholar
  36. 36.
    Mitchell JE, Lancaster KL, Burgard MA, Howell LM, Krahn DD, Crosby RD, et al. Long-term follow-up of patients’ status after gastric bypass. Obes Surg. 2001;11(4):464–8. doi: 10.1381/096089201321209341.CrossRefPubMedGoogle Scholar
  37. 37.
    Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56. doi: 10.1007/s11695-009-9895-6.CrossRefPubMedGoogle Scholar
  38. 38.
    Ivezaj V, Grilo CM. When mood worsens after gastric bypass surgery: characterization of bariatric patients with increases in depressive symptoms following surgery. Obes Surg. 2015;25(3):423–9. doi: 10.1007/s11695-014-1402-z.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Tindle HA, Omalu B, Courcoulas A, Marcus M, Hammers J, Kuller LH. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med. 2010;123(11):1036–42. doi: 10.1016/j.amjmed.2010.06.016.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Noah J. Switzer
    • 1
  • Estifanos Debru
    • 2
  • Neal Church
    • 2
  • Philip Mitchell
    • 2
  • Richdeep Gill
    • 3
  1. 1.Department of SurgeryUniversity of AlbertaEdmontonCanada
  2. 2.Department of SurgeryUniversity of CalgaryCalgaryCanada
  3. 3.Peter Lougheed HospitalUniversity of CalgaryCalgaryCanada

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