title: Five-year changes in psychiatric treatment status and weight-related comorbidities following bariatric surgery in a veteran population.
abstract: BACKGROUND
  Although bariatric surgery is an established treatment for obesity, less is known regarding the long-term effects of surgery on psychiatric function. This paper reports changes in psychiatric treatment status, weight, and weight-related comorbidities over 5 years of follow-up among a population of veterans completing bariatric surgery.
  
  
  METHODS
  We assessed 55 veterans undergoing bariatric surgery at a single Veteran Affairs medical center for 5 years post-surgery. Patients completed a pre-surgery clinical interview with a licensed psychologist. Using computerized medical records, we tracked pre- to post-surgery involvement with antidepressants, anxiolytics, psychotherapies, and overall psychiatric treatment visits along with changes in weight and metabolic function.
  
  
  RESULTS
  Rates of antidepressant use and/or involvement with psychotherapy for depression declined from 56.4 % at pre-surgery to 34.6 % at 5 years post-surgery, p = 0.01. Anxiolytic use and/or involvement with psychotherapy for anxiety, however, increased from 23.6 to 32.7 % pre- to 5 years post-surgery. Average psychiatric treatment volume remained similar to pre-surgery status across follow-up. These mixed indicators of psychiatric improvement occurred despite marked metabolic improvements from surgery. Mean percent excess weight loss = 51.7 and 41.3 (1 and 5 years post-surgery, respectively), systolic blood pressure (-6.8 mmHg (14.3)/-6.1 mmHg (12.8), respectively), glucose levels (-18.6 mg/dL (30.2)/-10.0 mg/dL (25.9), respectively), triglycerides (-78.2 mg/dL (96.7)/-69.1 mg/dL (102.2), respectively) and high-density lipoproteins (+7.1 (9.9)/+11.3 (11.3), respectively) levels each improved.
  
  
  CONCLUSIONS
  We report evidence of decreased antidepressant use and depression therapies following bariatric surgery, but no improvements on rates of anxiolytic use and anxiety therapies or on overall psychiatric treatment involvement. Despite metabolic improvements, bariatric patients with psychiatric histories may warrant ongoing attention to mental health.
authors.affiliation: VA San Diego Healthcare System, Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. thomas.rutledge@va.gov
authors.forename: Thomas
authors.initials: T
authors.lastname: Rutledge
authors.forename: Abby L
authors.initials: AL
authors.lastname: Braden
authors.forename: Gina
authors.initials: G
authors.lastname: Woods
authors.forename: Karen L
authors.initials: KL
authors.lastname: Herbst
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Groesz
authors.forename: Michelle
authors.initials: M
authors.lastname: Savu
mesh_terms: D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D000928:Antidepressive Agents / Q000008:administration & dosage; D001007:Anxiety / Q000453:epidemiology* / Q000628:therapy; D050110:Bariatric Surgery; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery; D011184:Postoperative Period; D011613:Psychotherapy; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D015431:Weight Loss
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents