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

  • EATING DISORDERS (S WONDERLICH AND S ENGEL, SECTION EDITORS)
  • Published:
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Abstract

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.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, MD, 21224, Baltimore, USA

    Janelle W. Coughlin

  2. North Dakota State University, College of Health Professions, ND, 58103, Fargo, USA

    Kristine J. Steffen

  3. Sanford Center for Biobehavioral Research, ND, 58103, Fargo, USA

    Kristine J. Steffen & James E. Mitchell

  4. University Health Network Bariatric Surgery Program Centre for Addiction and Mental Health University of Toronto, ON, M6J 1H4, Toronto, Canada

    Sanjeev Sockalingam

  5. University of North Dakota School of Medicine and Health Sciences, ND, 58103, Fargo, USA

    James E. Mitchell

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Coughlin, J.W., Steffen, K.J., Sockalingam, S. et al. Psychotropic Medications in Metabolic and Bariatric Surgery: Research Updates and Clinical Considerations. Curr Psychiatry Rep 24, 89–98 (2022). https://doi.org/10.1007/s11920-022-01317-4

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