Antidepressants and Bariatric Surgery

Antidepressants and Bariatric Surgery

Some antidepressants cause weight gain. Others suppress appetite and can help with weight loss. Below is a list of antidepressants that fit into three separate categories.





Antidepressants that may increase your weight:

Paxil - (this is known to be the worst to cause weight gain)
Elavil or other tricyclic antidepressants
Trazadone

Antidepressants that tend to be weight neutral. (After early weight loss patients tend to slowly gain weight over time.)

Prozac
Zoloft
Celexa

Antidepressants that often cause weight loss

Wellbutrin
Cymbalta
Effexor
Prestique

If you are taking an antidepressant that is known to cause weight gain or is weight neutral speak with your primary care physician or psychiatrist about the possibility of changing to an antidepressant that can assist you in losing weight or help you keep your weight off.

Please do not stop any antidepressant without consulting your doctor.

Am I able to take extended release medicines after my bariatric operation?

Patients that choose an adjustable gastric band or a gastric sleeve operation should still be able to absorb any medications prescribed since there has not been any changes in the small intestine. With the gastric sleeve procedure the stomach has been reduced in size and anything that is ingested may leave the stomach faster that prior to surgery but I doubt that this will be a significant problem with medicines. Therefore I do not recommend any changes in medications for people that choose to have either of these two operations.

However, patients that have a gastric bypass are choosing an operation that essentially allows the medications that are taken by mouth to pass directly into the small intestine. The time it takes to pass through the mouth through the small gastric pouch, through the available length of small intestine and into the large intestine, (also called the colon), is about 45 minutes. That will be fine for medications that are in a regular form since the small intestine is so efficient in absorbing these medications. However medicines taken in some forms will be effected by this change.

There are many ways the drug companies have made taking medicines easier for us. For instance, medications are sometimes “wrapped” into a pill that releases medications in two stages hours apart or in other preparations the medicine is released very slowly over several hours so a person only has to take the medicine once a day and instead of several times a day.

Unfortunately, to get all the medication that is in these extended release pills a patient needs a stomach that stores at least some of the medicine for a few hours slowly sending the medication out of the stomach a little at a time. The combination of an intact stomach and a small intestine that is of full length results in several hours between swallowing the pill until it would reach the large intestine. This allows extended release medications to work so they can slowly release the medicine over a long time.

A gastric bypass shortens the time so much that the person only has time to have the first part of the medicine released. Anything that would be released after 45 minutes is no longer available for absorption because the pill is likely to already be in the colon by that time.

A gastric bypass patient may be paying more for a specially designed extended release medicine but only absorbing half of it. You are probably just wasting your money and not benefiting as much as you should from extended release medicines.
Therefore I recommend that my patients avoid extended release medicines and take the medicines in a non-extended release form.

For example, Toprol is an extended release form of Lopressor, (metoprolol). You may have taken Toprol XL 100 mg prior to your gastric bypass operation. If you continue to take Toprol XL 100 mg daily after your operation you are likely to only absorb the first half on the pill and since Lopressor is a 12 hour medicine you are likely not to have the appropriate amount of medicine for the second half of the day. Therefore I would suggest that you change from the extended release form to the regular form of metoprolol and have your doctor prescribe it as Lopressor 50 mg twice a day.

In fact, I would suggest that you always ask your doctor about each of your medicines and ask to have the non-extended release form. Primary care doctors and psychiatrists may or may not be aware of these issues and you as the patient must remember to inform them of your new changes and request that the medicines that are prescribed for you are in the correct form.

This goes for over the counter medicines as well.. Read the labels and make sure the medicines are not extended release or delayed release medications. Ask your pharmacist if you are not sure.

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Should I avoid Non-Steroidal Anti-Inflammitory medicines after my bariatric operation?

The short answer is it depends on which operation you have chosen.

This class of drugs included Ibuprofen, Naprosyn, Motrin, Aleve, Meloxicam, Mobic, Celebrex and several other medicines. Asprin has some similar side effects of gastric irritation.

I do not know of any reason why patients that choose to have an adjustable gastric band or a gastric sleeve operation should not take these medicines. However I believe that a gastric bypass patient should avoid these medicines for life if at all possible.

In general patients that have an adjustable gastric band or a gastric sleeve procedure may take these medicines. Of course there are risks of a gastric ulcer, bleeding or cardiovascular risks but that is the same as for people that do not have a bariatric operation.

For gastric bypass patients I suggest they avoid all of these medicines for life unless it is really medically necessary.

That is because these all can cause ulceration in the gastric pouch which may result in scarring and narrowing at the connection between the gastric pouch and the small intestine. This can result in vomiting and may require dilation of the narrowing by a special balloon during an endoscopy, (passing a scope into the through the mouth into the stomach).

Let me tell you a story to demonstrate what I mean. Several years ago I had someone who had a gastric bypass operation a few years before in Colorado. She returned to Ohio where her family lived and came into our emergency room with complaints of vomiting. She had also lost a lot of additional weight over recent weeks and she looked dehydrated as well. She had been taking a few Naprosyn tablets daily for pain in her knees. She told me no one had told her she should not take non-steroidal anti-inflammatory medicines. I admitted her to the hospital and looked into her gastric pouch with a scope the following day, I found that she had a very small opening that a pencil point could not even go through. I was able to pass a guide wire through and into the small intestine and then passed a dilating balloon across the narrowing. After inflating the balloon I was able to dilate this area. She did well for a few days but soon this narrowed again. I dilated the area again only to have it narrow again a few days later. Eventually I had to take her to the operating room to make a completely new connection between the gastric pouch and the small intestine.

Also this ulcer may cause very significant bleeding and even perforation with leakage of gastric contents into the abdomen requiring an emergency operation.
For all of these reasons I strongly suggest that these medicines be avoided after a gastric bypass operation.

When I tell people this at the Fresh Start Seminar they frequently ask what other suggestions do I have to help them with their joint and back pain. First, I tell them that most people will not need these medications after they lose their weight from bariatric surgery. This of course will decrease the weight on their joints and relieve much of the pressure. Usually our patient lose about 60 lbs in the first three months after bariatric surgery so the feel much better shortly after their operation. Secondly that have access to pain medicine after surgery such as Percocet or Vicodin for a little while. Sometimes I will suggest Ultracet or extra strength Tylenol. Occasionally someone will need to be on a Fentanyl patch for a few weeks or see a sports medicine doctor or orthopedist for a steroid injection. Finally, if the pain is too limiting for them I will agree to place then of Celebrex at about 3 months after their operation but they are informed there is still a risk of these problems even with Celebrex.

I am sure that other bariatric surgeons may feel differently about these matters but this is how I have chosen to instruct our patients and I find that it keeps them from having problems after their operation in they follow these directions.
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