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

After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB). In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects' medical records; pre- and postoperative well-being scores were compared. Of the study population, mean age was 50.6 +/- 9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1 +/- 23.6 kg (295 +/- 52 lb) and 170.0 +/- 29.1 kg (374.0 +/- 64.0 lb) for females and males, respectively, p or =15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR) = 5.10, 95% CI 1.83-14.29, p = 0.002), severely decreased postoperative well-being (OR = 21.5, 95% CI 2.50-183.10, p < 0.0001), and concerns over alcohol or drug use (OR = 12.74, 95% CI 1.73-93.80, p = 0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR = 0.94 for each unit increase, 95% CI 0.91- 0.98, p = 0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR = 0.54, 95% CI 0.30-0.98, p = 0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model. Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB.

The relationship between depression and severe obesity is unclear. We examined depression before and after surgically induced weight loss. Beck Depression Inventory (BDI) questionnaires were completed before and at yearly intervals after gastric-restrictive weight-loss surgery. We used the BDI scores of 487 consecutive patients to identify predictors of depression. Scores from all completed questionnaires were used to follow changes with time. Paired preoperative and 1-year postoperative scores (n = 262) were used to identify predictors of change in BDI score. For the 487 subjects, the mean +/- SD preoperative BDI score was 17.7 +/- 9.5. Higher scores, indicating increased symptoms of depression, were found in younger subjects, women, and those with poorer body image. These factors had independent effects. We found no association between BDI and waist circumference or insulin concentrations. High BDI scores correlated with poorer physical and mental quality-of-life measures. Weight loss was associated with a significant and sustained fall in BDI scores, with a mean +/- SD score of 7.8 +/- 6.5 at 1 year and 9.6 +/- 7.7 at 4 years after surgery. Greater falls in BDI score at 1 year were seen in women, younger subjects, and those with greater excess weight loss (combined r2 = 0.10; P<.001). Fall in BDI score correlated with improvement in appearance evaluation (r = -0.31; P<.001). Severely obese subjects, especially younger women with poor body image, are at high risk for depression. We found sustained improvement with weight loss. These findings also support the hypothesis that severe obesity causes or aggravates depression.

Candidates for bariatric surgery frequently have co-morbid psychiatric problems. This study investigated the course and the prognostic significance of preoperative and postoperative anxiety and depressive disorders in 107 extremely obese bariatric surgery patients in a prospective design with face-to-face interviews (SCID) conducted prior to the surgery and postoperatively after 6-12 months and 24-36 months. The point prevalence of depressive disorders but not of anxiety disorders decreased significantly after surgery. Preoperative depressive disorders predicted depressive disorders 24-36 months but not 6-12 months after surgery, whereas preoperative anxiety significantly predicted postoperative anxiety disorders at both follow-up time points. Preoperative lifetime and current depressive disorders were unrelated to postoperative weight loss whereas preoperative lifetime, but not current anxiety disorders were of negative prognostic value for postoperative weight loss. Patients with both depressive and anxiety disorders at baseline (current and lifetime) lost significantly less weight after surgery. Postoperative anxiety disorder was not associated with the degree of weight loss at any follow-up time-point; however postoperative depressive disorder was negatively associated with weight loss at the 24-36 month follow-up assessment point. Missing data, limited statistical power, self-reported height and weight are the limitations of this study. As opposed to anxiety disorders, the point prevalence of depressive disorders decreased significantly after bariatric surgery. However, the presence of depressive disorders after bariatric surgery significantly predicted attenuated post-surgical improvements and may signal a need for clinical attention. Copyright © 2011 Elsevier B.V. All rights reserved.