Does Long-Term Post-Bariatric Weight Change Differ Across Antidepressants?

David E Arterburn; Matthew L Maciejewski; Theodore S Z Berkowitz; Valerie A Smith; James E Mitchell; Chuan-Fen Liu; Adenike Adeyemo; Katharine A Bradley; Maren K Olsen

doi:10.1097/AS9.0000000000000114

Does Long-Term Post-Bariatric Weight Change Differ Across Antidepressants?

Ann Surg Open. 2022 Jan 10;3(1):e114. doi: 10.1097/AS9.0000000000000114. eCollection 2022 Mar.

Authors

David E Arterburn^{1

2}, Matthew L Maciejewski^{3

4

5}, Theodore S Z Berkowitz³, Valerie A Smith^{3

4

5}, James E Mitchell⁶, Chuan-Fen Liu⁷, Adenike Adeyemo³, Katharine A Bradley^{1

2

7}, Maren K Olsen^{3

8}

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, Seattle, WA.
² Department of Medicine, University of Washington, Seattle, WA.
³ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, NC.
⁴ Department of Population Health Sciences, Duke University, Durham, NC.
⁵ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC.
⁶ University of North Dakota School of Medicine and Health Sciences, Fargo, ND.
⁷ Department of Health Services, University of Washington, Seattle, WA.
⁸ Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.

Abstract

We sought to evaluate whether weight change up to 5 years after bariatric surgery differed by antidepressant class taken before surgery.

Background: Bariatric surgery induces significant weight loss, but outcomes are highly variable. The specific type of antidepressant used prior to surgery may be an important factor in long-term weight loss.

Methods: This retrospective cohort study from 2000 to 2016 compared the 5-year weight loss of 556 Veterans who were taking antidepressant monotherapy (bupropion, selective serotonin reuptake inhibitors [SSRIs], or serotonin-norepinephrine reuptake inhibitors [SNRIs]) before bariatric surgery (229 sleeve gastrectomy and 327 Roux-en-Y gastric bypass) versus 556 matched nonsurgical controls.

Results: Patients taking bupropion before sleeve gastrectomy had greater differential weight loss between surgical patients and matched controls than those taking SSRIs at 1 (8.9 pounds; 95% confidence interval [CI], 1.6-16.3; P = 0.02) and 2 years (17.6 pounds; 95% CI, 5.9-29.3; P = 0.003), but there was no difference at 5 years (11.9 pounds; 95% CI, -8.9 to 32.8; P = 0.26). Findings were similar for gastric bypass patients taking bupropion compared to SSRIs at 1 (9.7 pounds; 95% CI, 2.0-17.4; P = 0.014), 2 (12.0 pounds; 95% CI, -0.5 to 24.5; P = 0.06), and 5 years (4.8 pounds; 95% CI, -16.7 to 26.3; P = 0.66). No significant differences were observed comparing patients taking SNRI versus SSRI medications.

Conclusions: Sleeve gastrectomy and gastric bypass patients taking bupropion had greater weight loss than those taking SSRIs, although these differences may wane over time. Bupropion may be the first-line antidepressant of choice among patients with severe obesity considering bariatric surgery.

Keywords: antidepressants; bariatric; bupropion; gastric bypass; matching; sleeve gastrectomy; veterans; weight.