Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada.
J Affect Disord. 2019 Mar 1;246:886-894. doi: 10.1016/j.jad.2018.12.113. Epub 2018 Dec 28.
No previous review has comprehensively assessed long-term changes in anxiety and depressive symptoms in bariatric surgery patients. This systematic review assessed the effects of bariatric surgery on long-term reductions (≥ 24 months) in anxiety and depressive symptom severity in morbidly obese (≥ 35 BMI kg/m) participants. Short term effects (< 24 months) are briefly reviewed for context.
PsychINFO, Google Scholar and PubMed databases were systematically searched for prospective cohort studies published from inception to 14 June 2018 that evaluated long-term (≥ 24 months) changes in anxiety and depressive symptom severity in bariatric surgery patients with a BMI ≥ 35 kg/m using a combination of the following search terms: bariatric surgery (and surgical approaches included under this term), obesity, depression, depressive disorder, anxiety, anxious, psychiatric disorders, mood disorders.
We reviewed 2058 articles for eligibility; 14 prospective studies were included in the systematic review. 13 studies (93%) reported significant reductions in depressive symptom severity 2-3 years after bariatric surgery. However, all studies recorded statistically significant reductions in depressive symptoms at the conclusion of the study. Similarly, there were reductions in overall anxiety symptom severity at ≥ 24 months follow-up (k = 8 studies, n = 1590 pooled). Pre-operative anxiety or depression scores did not predict outcomes of post-operative BMI. Similarly, post-surgery weight loss did not predict changes in anxiety symptoms.
Very few studies assessed anxiety or depression as a primary outcome. Therefore, we cannot suggest bariatric surgery as a stand-alone therapeutic tool for anxiety and depression based on our findings.
Currently available evidence suggests that bariatric surgery is associated with long-term reductions in anxiety and depressive symptoms. This supports existing literature showing that metabolic treatments may be a viable therapeutic intervention for mood disorders.
先前的综述并未全面评估肥胖症患者接受减重手术后焦虑和抑郁症状的长期变化。本系统综述评估了减重手术对病态肥胖（BMI≥35kg/m²）患者长期（≥24 个月）降低焦虑和抑郁严重程度的影响。为了了解短期（<24 个月）的效果，我们简要地回顾了相关内容。
我们系统地检索了从建库至 2018 年 6 月 14 日发表的心理信息、谷歌学术和 PubMed 数据库中的前瞻性队列研究，评估了 BMI≥35kg/m²的肥胖症患者接受减重手术后长期（≥24 个月）焦虑和抑郁严重程度的变化，使用了以下搜索词的组合：减重手术（以及归入该术语的手术方法）、肥胖、抑郁、抑郁障碍、焦虑、焦虑、精神障碍、心境障碍。
我们对 2058 篇文章进行了资格审查，其中 14 项前瞻性研究纳入了系统综述。13 项研究（93%）报告称，减重手术后 2-3 年抑郁症状严重程度显著降低。然而，所有研究在研究结束时都记录了抑郁症状的统计学显著降低。同样，在≥24 个月的随访中，整体焦虑症状严重程度也有所降低（k=8 项研究，n=1590 例汇总）。术前焦虑或抑郁评分不能预测术后 BMI 的结果。同样，手术后的体重减轻也不能预测焦虑症状的变化。
很少有研究将焦虑或抑郁作为主要结局进行评估。因此，我们不能根据我们的发现建议将减重手术作为治疗焦虑和抑郁的独立治疗手段。
目前的证据表明，减重手术与长期降低焦虑和抑郁症状相关。这支持了现有文献表明代谢治疗可能是治疗心境障碍的可行治疗干预。
