Background

Obesity and mental health disorders often coexist, leading to high psychotropic medication prevalence among bariatric surgery patients. Psychotropic medications may cause weight gain, but little is known about how these medications affect weight loss after bariatric surgery.

Methods

We performed a retrospective, single center observational study of adult patients who underwent bariatric surgery from June 2017 to October 2021 at the University of Oklahoma. Clinical and demographic data were abstracted, including BMI and psychotropic medication use at baseline and 1-year. Behavioral testing results, including Beck’s Depression Inventory (BDI-II) and Beck’s Anxiety Inventory (BAI), administered at program initiation, were also collected. Statistical analysis was performed using student’s t-test and univariate analysis; p-values <0.05 were considered significant.

Results

53% of 122 patients (BMI 47.0±8.20) reported psychotropic medications at baseline. 1-year excess weight loss (%EBWL) was 73.2±21.5%. Depression severity was associated with medication use (p=0.013), but not 1-year %EBWL (NS). Compared with other psychotropic medications, women on bupropion had lower %EBWL (62.5±16% versus 75.0±20.5%, p=0.045). Tricyclic antidepressants were associated with greater %EBWL (p=0.022). In patients undergoing sleeve gastrectomy, selective serotonin reuptake inhibitors were associated with lower %EBWL (p=0.028), while mood stabilizers were associated with greater %EBWL (p=0.047).

Conclusions

Baseline psychotropic medication use in bariatric surgery patients appears to modulate weight loss at 1-year, however %EBWL was not affected by severity of mental health symptoms. Psychotropic medications may limit weight loss; as seen in women taking bupropion, which is often considered weight-neutral. Careful consideration should be taken when prescribing these medications.