Efficacy of estradiol topical patch in the treatment of symptoms of depression following mini-gastric bypass in women.
BACKGROUND
Obesity is associated with elevated levels of estrogen. Gastric bypass causes rapid weight loss and decreased levels of estrogen. Patients after gastric bypass can suffer from anxiety and depression out of proportion to the surgical outcome. This study reports the efficacy of a short-term empiric trial of topical estradiol for the treatment of mild to moderate depression and anxiety following mini-gastric bypass (MGB) in women.


METHODS
Postoperative MGB women were surveyed for the presence of depressive symptoms before and after MGB. The results of an empiric trial of transdermal patches of estradiol-17beta were assessed. Outcome measures were the self-reported efficacy of the patch.


RESULTS
711 women who had undergone MGB and had functioning e-mail addresses made up the study. 62% of patients reported depression prior to surgery. 156 patients (22%) reported depression after the operation. 130 women were treated empirically with the patch, and remission of depression was observed in 92 (71%). In response to the question "Did the estrogen patch help?", subjects reported responses of 1) Yes, fantastic, 2) Yes, somewhat, 3) Hard to say, 4) No, in 36%, 31%, 20%, 13% of respondents respectively. Patients treated with estradiol sustained antidepressant benefit of treatment after the patch was discontinued. Treatment lasted <1 month, 1-3 months, and >3 months, in 48%, 32% and 20% respectively. Treatment was well-tolerated and adverse events were rare.


CONCLUSIONS
Depression is common in obese patients and remains a problem in a subset following the MGB operation. Transdermal estradiol replacement appears to be an effective treatment of symptoms of depression in women following MGB.
Rutledge
Robert
R
The Centers for Excellence in Laparoscopic Obesity Surgery, Henderson, NV, USA. DrR@clos.net
Dorghazi
Paul
P
Peralgie
Cesare
C
D000279:Administration, Cutaneous; D000328:Adult; D003866:Depressive Disorder / Q000188:drug therapy* / Q000209:etiology*; D004334:Drug Administration Schedule; D004958:Estradiol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery*; D017060:Patient Satisfaction; D016896:Treatment Outcome
D004958:Estradiol