When Mood Worsens after Gastric Bypass Surgery: Characterization of Bariatric Patients with Increases in Depressive Symptoms Following Surgery

Abstract

Background Depression levels generally decrease substantially following bariatric surgery; however, little is known about bariatric patients who might experience increases in depression following surgery. We examined the frequency of bariatric patients who experienced discernible increases in depression levels following surgery and explored their correlates. Methods Participants were 107 patients with extreme obesity who underwent gastric bypass surgery and were followed up at 6 and 12 months postsurgery. Participants completed self-report questionnaires about depression (BDI), eating disorder psychopathology (EDE-Q), self-esteem (RSES), and social functioning (SF-36) at baseline and again at 6 and 12 months postsurgery. Results Fourteen (13.1 %) participants reported discernible increases (BDI-Increase), 14 (13.1 %) reported discernible decreases (BDI-Decrease), and 79 (73.8 %) did not report discernible changes (no change) in BDI scores from 6 to 12 months postsurgery. Presurgically, there were no differences between the three groups. By 12 months postsurgery, the BDI-Increase group had significantly higher depression scores and significantly lower self-esteem and SF-36 mental component scores than did the other groups. For the BDI-Increase group, BDI Change was significantly associated with body mass index, self-esteem, and SF-36 physical component scores. Conclusions Findings highlight that a subgroup of individuals report discernible increases in depressive scores postsurgery and may differ in potentially clinically meaningful ways from those who do not report discernible increases in depressive symptoms. Future research is needed to better understand the long-term trajectory of patients with discernible worsening mood following gastric bypass surgery.

Health-related quality of life and psychological functioning 9 years after restrictive surgical treatment for obesity

“…Therefore, it can be assumed that the decline in mental health during this period was related to factors other than weight regain. For example, the deterioration in improvement of mood may have been caused by disappointment from unrealistic expectations about surgical treatment or by the reoccurrence of psychiatric disorders [2,3,19]. Furthermore, changes in eating behavior, medical sequelae after surgery (e.g., plugging), the fear of weight regain leading in some cases to disturbed eating [19][20][21], dissatisfaction with body appearance and excess skin [22][23][24], or the persistence of problems after weight loss that are blamed on obesity may have contributed to the decline [19,25,26].…”

Obesity and Chronic Pain

“…181,209,210 Concerning reports indicate that some patients (13%) suffer from worsened depression after bariatric surgery. 211 Another worrisome finding was that despite positive weight-loss outcomes, 77% of patients who were chronic opioid users before bariatric surgery continued such use after surgery, and "the amount of chronic opioid use was greater postoperatively than preoperatively." 212 A factor strongly associated with chronic opioid use postsurgery was presurgery opioid total days' supply of nonnarcotic analgesics, antianxiety medications, and tobacco.…”

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

“…152 However, other studies suggest that improvements following surgery may not be maintained after the first postoperative year 151 and depressive symptoms may deteriorate in some patients. 153 Previous reports have often drawn on data from hospital-based series that did not include control groups, often with short durations of follow-up.…”