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

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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. 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, w...

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