Page 55 - tmp

Perioperative Antidepressant Use in Patients Who Undergo Bariatric Surgery
than 0.05 were considered indicative of statistical significance. Data dIscussIon
were analyzed using R statistical software via the R Foundation for
Statistical Computing 2017 (version 3.43, Vienna, Austria). Our study results indicate that the majority of patients who undergo
bariatric surgery will see an improvement in their body image, and
the magnitude to which this improvement is seen is influenced
results by the improvement in the BMI and being on an antidepressant.
The study sample included 47 men and 57 women ranging Specifically for every 1 point of BMI improvement, our sample
from 22 to 72 years of age (mean age 44.28 years). Preoperative increased their body image scores by 0.68 points, (p = 0.021) and
BMI ranged from 35.87 to 75.66 (mean BMI 49.26). Over 72% those who were taking an antidepressant scored an average of
(72.63%) provided comparison information for 3 months, (75.78%) 8.55 points higher on the body image scores than those who
6 months, and (63.15%) 12 months. Sixty-nine percent (69%) of our were not taking an antidepressant (p = 0.032). The results of our
samples were taking psychiatric medications, and 57% of those study reflect similar concepts found in the literature. Overall,
medications were antidepressants. Represented antidepressants in there are significant improvements seen in body image following
our sample included: amitriptyline (5), bupropion (10), citalopram bariatric surgery, and these improvements often correlate with
(34), duloxetine (4), escitalopram (9), fluoxetine (6), nortriptyline the percentage of weight loss and can similarly decompensate if
(1), paroxetine (3), sertraline (4), venlafaxine (1), vilazodone (4), weight is regained. 2,7–9,30–37 In addition, there are multiple studies
and vortioxetine (3). Noted 35 patients were on >1 psychotropic demonstrating that treating a psychiatric comorbidity can result in
medication and 9 of those patients were on >1 antidepressant. more favorable “nonpsychiatric” outcomes. For example, a recent
Fifty-three percent (53.65%) underwent Roux-en-Y gastric randomized controlled trial (RCT) showed that congestive heart
bypass and (46.35 %) underwent vertical sleeve gastrectomy. failure patients who achieved clinical remission of depression
The improvement in BMI ranged from 1.44 points to 30.77 points demonstrated a statistically significant reduction in cardiovascular
(average of 15.08 BMI improvement points). For further details of events compared to the nonremission group. 38 In another RCT,
these patient demographics, see Table 1. patients with breast cancer undergoing adjuvant hormonal
The majority (98.07%) of our patient sample demonstrated therapy, local radiation, and/or adjuvant chemotherapy reported
improved scores on the BESAA metrics and two factors revealed that antidepressant treatment reduced depressive symptoms,
statistical significance regarding the influence of score magnitude. improved quality of life, and increased the likelihood of completion
The first factor, as expected, was BMI improvement demonstrating of adjuvant treatment vs the placebo group. Considering the high
39
a coefficient of 0.684 (p = 0.021). Hence, for every 1 point of BMI prevalence of depression in the bariatric surgery population, it is
improvement, our sample increased their BESAA scores by 0.68 understandable that a treatment for depression could produce
points. The second factor of statistical significance was perioperative a more favorable outlook on one’s body image. This trend has
antidepressant use with a coefficient of 8.556 (p = 0.032). Hence, been seen with psychotherapeutic interventions perioperatively.
those in our sample who were taking an antidepressant scored For example, cognitive behavioral therapy (CBT) was shown
an average of 8.55 points higher on the BESAA scores than those to improve distress related to body image as well as reported
who were not taking an antidepressant. There were no significant self-esteem and depression symptoms. 40–42 In addition, acceptance
differences found regarding the influence on the BESAA scores in and commitment therapy demonstrated significant improvements
age, gender, race, type of surgery, use of anxiolytics/hypnotics, or in body image and weight concerns compared to treatment as
stimulants (Table 2). We excluded education and employment status usual. 7,43,44
due to the lack of patient responses on these surveys. Body image dissatisfaction and depression not only act
as single factors that can impede success in a patient’s weight
Table 2: Linear regression for demographic influence on body image loss journey but also interact with each other in a bidirectional
improvement manner. 11,12 In fact, poor body image has been proposed to mediate
Demographic characteristics Coefficient p-value the relationship between obesity and psychological symptoms
45
Age 0.039 0.784 of depression and low self-esteem. Bodily dissatisfaction and
Sex psychological distress can act as a trigger for stress-related eating
46
behaviors. In addition, among individuals seeking bariatric
Male* 1.00 1.00 surgery, body image dissatisfaction was associated with binge
Female −4.726 0.266 eating, depression, and lower self-esteem. 7,47 The literature also
Race/ethnicity suggests that if a patient is not prepared psychologically for
Caucasian* 1.00 1.00 body image challenges after bariatric surgery, there is a higher
48
Non-Caucasian 4.988 0.154 likelihood of experiencing disturbed body image postoperatively.
Postoperative BMI improvement 0.684 0.021** As mentioned earlier, depression has been shown to increase the
19
20
Surgical procedure risk of diabetes 1.4-fold, coronary artery disease 1.5- to 2-fold,
21
Roux-en-Y gastric bypass* 1.00 1.00 and stroke 1.8-fold, to name a few. These risk increases are likely
mediated by both biological mechanisms and unhealthy behaviors
Vertical sleeve gastrectomy 0.039 0.822 related to poor self-care, diet, exercise, and treatment adherence,
Psychiatric medications thereby contributing to increased morbidity and mortality. In
49
Antidepressant 8.556 0.032** fact, comorbid depression is associated with a 3-fold greater risk
Anxiolytic/hypnotic 0.993 0.743 of nonadherence to medical treatment ranging from medication
Stimulant 4.993 0.366 nonadherence to missing appointments to not following diet,
50
*Reference groups; **Statistically significant level: p <0.05; BMI, body exercise, or lifestyle recommendations. Studies show that this
mass index increased mortality rate persists even after confounding factors
128 World Journal of Laparoscopic Surgery, Volume 14 Issue 2 (May–August 2021)