The Impact of Bariatric Surgery on Depression: a Review
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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.
KeywordsBariatric surgery Depression Obesity Review
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The authors declare that they have no conflicts of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 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
- 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.•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
- 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
- 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