Changes In Serum Concentration of Antidepressants after Bariatric Surgery and Recommendations for Post-Bariatric Surgery Antidepressant Therapy

OBJECTIVES:Our objectives were to review publicly available data regarding changes in antidepressant serum concentration following bariatric surgery in order to develop medication dosing recommendations in this patient population METHODS: A comprehensive literature review was performed utilizing key search terms in Pubmed. Additional data were retrieved from FDA and DrugBank Online resources. RESULTS:A total of twelve published articles were included in addition to the publicly available data from FDA and DrugBank. The serum concentration of antidepressants following bariatric surgery demonstrated considerable variability between and within drug classes due to unique pharmacokinetic features, drug preparation, and formulation. Recommendations were developed from published data regarding changes in serum concentration and drug-specific pharmacokinetic data. CONCLUSION:To our knowledge this is the first study to propose medication dose-adjustment recommendations for patients on antidepressants undergoing bariatric surgery. We were limited by the relatively small amount of data available and recommend monitoring patients and use of clinical judgment along with this guidance.