Psychiatric Management of Bariatric Surgery Patients: A Review of Psychopharmacological and Psychological Treatments and Their Impact on Postoperative Mental Health and Weight Outcomes

Sanjeev Sockalingam; Samantha E Leung; Susan Wnuk; Stephanie E Cassin; Richard Yanofsky; Raed Hawa

doi:10.1016/j.psym.2020.04.011

Psychiatric Management of Bariatric Surgery Patients: A Review of Psychopharmacological and Psychological Treatments and Their Impact on Postoperative Mental Health and Weight Outcomes

Psychosomatics. 2020 Sep-Oct;61(5):498-507. doi: 10.1016/j.psym.2020.04.011. Epub 2020 Apr 24.

Authors

Sanjeev Sockalingam¹, Samantha E Leung², Susan Wnuk³, Stephanie E Cassin⁴, Richard Yanofsky³, Raed Hawa³

Affiliations

¹ Centre for Mental Health, University Health Network, Toronto, ON, Canada; Bariatric Surgery Program, Toronto Western Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada. Electronic address: sanjeev.sockalingam@camh.ca.
² Centre for Mental Health, University Health Network, Toronto, ON, Canada; Bariatric Surgery Program, Toronto Western Hospital, Toronto, ON, Canada.
³ Centre for Mental Health, University Health Network, Toronto, ON, Canada; Bariatric Surgery Program, Toronto Western Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁴ Centre for Mental Health, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychology, Ryerson University, Toronto, ON, Canada.

PMID: 32451127
DOI: 10.1016/j.psym.2020.04.011

Abstract

Background: Bariatric surgery is an effective treatment for severe obesity; however, high rates of psychiatric comorbidity complicate bariatric surgery care. As a result, importance has been placed on the need for ongoing psychiatric support in patients undergoing bariatric surgery. Given the lack of conclusive presurgery psychosocial predictors of postoperative mental health outcomes, studies have now shifted their focus to understand the long-term psychosocial sequalae that arise after surgery. Increasing evidence has demonstrated the potential for psychiatric care to stabilize psychiatric symptoms and minimize patient distress.

Objective: To review psychopharmacological and psychological interventions for patients undergoing bariatric surgery and their impact on mental health and weight outcomes after surgery.

Methods: We performed a comprehensive literature search in Ovid MEDLINE for studies examining the impact of psychopharmacological and psychological treatments on bariatric patients' postoperative mental health and weight outcomes.

Results: Overall, 37 studies were included in the review. Preliminary evidence suggests that psychiatric medications do not negatively impact weight loss or health-related quality of life in the short term; however, more rigorous research designs are needed. There are insufficient data on specific psychiatric medications and long-term impact on weight loss and psychosocial outcomes. Postoperative psychological interventions have evidence for improving eating psychopathology, anxiety, and depressive symptoms; however, effects on weight loss remain unclear.

Conclusion: Evidence for psychopharmacological and psychological treatments remains preliminary. Consideration should be given to integrated, stepped-care models to provide personalized psychiatric interventions after surgery. Future research on expanding current psychiatric interventions, timing of delivery, and predictors of response is needed.

Keywords: behavioral medicine; eating disorder; mental health; psychopharmacology; psychotherapy.

Publication types

Review

MeSH terms

Anxiety Disorders / complications
Bariatric Surgery / psychology*
Feeding and Eating Disorders / complications
Humans
Mental Health*
Psychotherapy
Quality of Life