Psychotropic Medications in Metabolic and Bariatric Surgery: Research Updates and Clinical Considerations

• Published in: Current psychiatry reports Vol. 24; no. 1; pp. 89 - 98
• Main Authors: Coughlin, Janelle W., Steffen, Kristine J., Sockalingam, Sanjeev, Mitchell, James E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 2022; Springer Nature B.V
• Subjects: Antidepressive Agents - therapeutic use; Bariatric Surgery - adverse effects; Eating Disorders (S Wonderlich and S Engel; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Mental Disorders - drug therapy; Mental Disorders - epidemiology; Metabolism; Pharmacokinetics; Psychiatry; Psychotropic drugs; Psychotropic Drugs - adverse effects; Section Editors; Topical Collection on Eating Disorders; Weight Gain; Psychotropic medication; Psychiatric medication; Pharmacokinetics, Antidepressants; Bariatric surgery
• ISSN: 1523-3812; 1535-1645
• DOI: 10.1007/s11920-022-01317-4

Purpose of Review We review evidence for assessing and monitoring psychotropic medications in metabolic and bariatric surgery (MBS) patients. We describe weight gain side effects, potential perioperative risks, pharmacokinetic changes that occur after MBS, and conclude with clinical recommendations. Recent Findings Research on psychiatric medication use and post-MBS weight outcomes is lacking and inconsistent; however, there is consistent evidence that, though variable, psychiatric medication use is associated with weight gain. Several meta-analyses and reviews provide guidance on lowering risk when appropriate. Perioperative lithium toxicity and SSRI discontinuation syndrome also warrant consideration, as do potential post-operative pharmacokinetic changes. In the absence of data for each psychiatric drug classification, close symptom monitoring and, where appropriate, serum concentration monitoring are recommended. Summary MBS patients are a psychiatrically vulnerable population, and many are on psychiatric medications. Given potential weight/metabolic side effects, perioperative complications, and post-operative pharmacokinetic changes that occur with psychotropic medication use, providers should stay well informed on psychiatric medication management considerations.