title: Treating mood disorders in patients with a history of intestinal surgery: a systematic review.
abstract: Bariatric surgery is increasingly being performed, with the intended benefits of significant and durable weight loss. Radical surgical resection can result in short bowel syndrome (SBS), a rare and devastating condition. Psychological distress is common in these patients. Relevant articles were identified by searching Pubmed and EMBASE databases with the following keywords: 'Bariatrics'[Mesh] OR 'Short Bowel Syndrome' AND 'Antidepressive Agents' OR 'Psychotropic Drugs'[Mesh]. One in-vitro study, four clinical studies and six relevant case reports were identified. Most clinical studies on antidepressant focused on the Roux-en-Y gastric bypass (RYGB); these results are somewhat conflicting for a variety of reasons including different methodologies and small sample sizes. One month after RYGB, in patients receiving serotonin or serotonin/noradrenaline reuptake inhibitors, antidepressant levels decrease to 50% of preoperative levels and return to baseline (or greater) by 6 months in almost all patients. Other pharmacokinetic studies have shown that, 1 year after RYGB, duloxetine and sertraline levels are significantly reduced in comparison with the control population. Paradoxically, in patients with SBS and a few years after surgery, high concentration to dose ratios have been reported for citalopram and escitalopram; this may be because of an intestinal adaptation. Surgery of the intestine is likely to modify absorption and first-pass metabolism of drugs; managing the treatment of depression and anxiety in bariatric and SBS patients therefore presents a major challenge. Close clinical follow-up, associated with therapeutic drug monitoring when available, should enable the optimization of treatment response and modulate the risk of adverse events.
authors.affiliation: aInserm, UMR-S 1144 Paris Descartes-Paris Diderot Universities, Variability of response to psychotropic agents, Paris, France bUnit of Psychopharmacology, Department of Pharmacology and Toxicology, Gevena University Hospitals, Geneva, Switzerland cAvon and Wiltshire Mental Health NHS Trust, Blackberry Hill Hospital, Bristol, UK.
authors.forename: Célia
authors.initials: C
authors.lastname: Lloret-Linares
authors.forename: Frank
authors.initials: F
authors.lastname: Bellivier
authors.forename: Kyle
authors.initials: K
authors.lastname: Heron
authors.forename: Marie
authors.initials: M
authors.lastname: Besson
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D050110:Bariatric Surgery / Q000523:psychology* / Q000639:trends*; D013505:Digestive System Surgical Procedures / Q000523:psychology / Q000639:trends; D006801:Humans; D019964:Mood Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents