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Published Online: 1 March 2012

The Effect of Gastric Bypass on the Pharmacokinetics of Serotonin Reuptake Inhibitors

Giselle G. Hamad, M.D., Joseph C. Helsel, B.S., James M. Perel, Ph.D., Gina M. Kozak, P.A.-C., Mary C. McShea, M.S., Carolyn Hughes, M.S.W., Andrea L. Confer, B.A., Dorothy K. Sit, M.D., Carol A. McCloskey, M.D., and Katherine L. Wisner, M.D., M.S.Authors Info & Affiliations

Publication: American Journal of Psychiatry

Volume 169, Number 3

https://doi.org/10.1176/appi.ajp.2011.11050719

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Abstract

Morbidly obese patients treated with serotonin reuptake inhibitors for mood and anxiety disorders frequently relapse following gastric bypass surgery. Of 12 patients followed, drug absorption 1 month postoperatively dropped to an average of 54% of preoperative levels (range: 36%–80%) in eight patients but returned to baseline levels by 6 months for six patients. Those who relapsed into depression with low blood levels frequently failed to lose weight as well.

Abstract

Objective:

Morbidly obese patients frequently present with mood and anxiety disorders, which are often treated with serotonin reuptake inhibitors (SRIs). Having observed that patients treated with SRIs frequently relapse after Roux-en-Y gastric bypass surgery, the authors sought to assess whether SRI bioavailability is reduced postoperatively.

Method:

Twelve gastric bypass candidates treated with an SRI for primary mood or anxiety disorders were studied prospectively. Timed blood samples for SRI plasma levels were drawn for pharmacokinetic studies before surgery and 1, 6, and 12 months afterward. Maximum concentration, time to maximum concentration, and area under the concentration/time curve (AUC) were determined.

Results:

In eight of the 12 patients, AUC values 1 month after surgery dropped to an average of 54% (SD=18) of preoperative levels (range=36%–80%); in six of these patients, AUC values returned to baseline levels (or greater) by 6 months. Four patients had an exacerbation of depressive symptoms, which resolved by 12 months in three of them. Three of the four patients had a reduced AUC level at 1 month and either gained weight or failed to lose weight between 6 and 12 months. Normalization of the AUC was associated with improvement in symptom scores.

Conclusions:

Patients taking SRIs in this study were at risk for reduced drug bioavailability 1 month after Roux-en-Y gastric bypass. The authors recommend close psychiatric monitoring after surgery.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry

Go to American Journal of Psychiatry

American Journal of Psychiatry

Volume 169 • Number 3 • March 2012

Pages: 256 - 263

PubMed: 22407114

History

Received: 12 May 2011

Revision received: 21 September 2011

Accepted: 17 October 2011

Published online: 1 March 2012

Published in print: March 2012

Authors

Details

Giselle G. Hamad, M.D.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Joseph C. Helsel, B.S.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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James M. Perel, Ph.D.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Gina M. Kozak, P.A.-C.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Mary C. McShea, M.S.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Carolyn Hughes, M.S.W.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Andrea L. Confer, B.A.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Dorothy K. Sit, M.D.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Carol A. McCloskey, M.D.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Katherine L. Wisner, M.D., M.S.

From the Departments of Surgery, Pharmacology, and Psychiatry, University of Pittsburgh; Western Psychiatric Institute and Clinic of UPMC; and Magee-Women's Hospital of UPMC, Pittsburgh.

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Notes

Address correspondence to Dr. Hamad ([email protected]).

Funding Information

Dr. McCloskey has served as a consultant to Allergan. Dr. Perel has served as an expert witness on atomoxetine and other non-psychostimulants in the treatment of ADHD for a consortium of pharmaceutical companies. Dr. Wisner has received advisory board payments from Eli Lilly and has received donations of active and placebo estradiol patches for an NIMH-funded study from Novartis. The other authors report no financial relationships with commercial interests.Supported by a research grant award from the American Society for Metabolic and Bariatric Surgery; grant MO1-RR000056 from the NIH National Center for Research Resources, General Clinical Research Centers; and Clinical and Translational Science Award grant 1 UL 1 RR024153-01. Dr. Wisner's time was supported by NIMH grant R01 075921.

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