Arterburn David E, Maciejewski Matthew L, Berkowitz Theodore S Z, Smith Valerie A, Mitchell James E, Liu Chuan-Fen, Adeyemo Adenike, Bradley Katharine A, Olsen Maren K
Kaiser Permanente Washington Health Research Institute, Seattle, WA.
Department of Medicine, University of Washington, Seattle, WA.
Ann Surg Open. 2022 Jan 10;3(1):e114. doi: 10.1097/AS9.0000000000000114. eCollection 2022 Mar.
We sought to evaluate whether weight change up to 5 years after bariatric surgery differed by antidepressant class taken before surgery.
Bariatric surgery induces significant weight loss, but outcomes are highly variable. The specific type of antidepressant used prior to surgery may be an important factor in long-term weight loss.
This retrospective cohort study from 2000 to 2016 compared the 5-year weight loss of 556 Veterans who were taking antidepressant monotherapy (bupropion, selective serotonin reuptake inhibitors [SSRIs], or serotonin-norepinephrine reuptake inhibitors [SNRIs]) before bariatric surgery (229 sleeve gastrectomy and 327 Roux-en-Y gastric bypass) versus 556 matched nonsurgical controls.
Patients taking bupropion before sleeve gastrectomy had greater differential weight loss between surgical patients and matched controls than those taking SSRIs at 1 (8.9 pounds; 95% confidence interval [CI], 1.6-16.3; = 0.02) and 2 years (17.6 pounds; 95% CI, 5.9-29.3; = 0.003), but there was no difference at 5 years (11.9 pounds; 95% CI, -8.9 to 32.8; = 0.26). Findings were similar for gastric bypass patients taking bupropion compared to SSRIs at 1 (9.7 pounds; 95% CI, 2.0-17.4; = 0.014), 2 (12.0 pounds; 95% CI, -0.5 to 24.5; = 0.06), and 5 years (4.8 pounds; 95% CI, -16.7 to 26.3; = 0.66). No significant differences were observed comparing patients taking SNRI versus SSRI medications.
Sleeve gastrectomy and gastric bypass patients taking bupropion had greater weight loss than those taking SSRIs, although these differences may wane over time. Bupropion may be the first-line antidepressant of choice among patients with severe obesity considering bariatric surgery.
我们试图评估减肥手术前服用的抗抑郁药类别是否会影响术后5年内的体重变化。
减肥手术可显著减轻体重，但结果差异很大。手术前使用的特定抗抑郁药类型可能是长期体重减轻的重要因素。
这项2000年至2016年的回顾性队列研究比较了556名在减肥手术前接受抗抑郁药单一疗法（安非他酮、选择性5-羟色胺再摄取抑制剂[SSRIs]或5-羟色胺-去甲肾上腺素再摄取抑制剂[SNRIs]）的退伍军人（229例行袖状胃切除术和327例行Roux-en-Y胃旁路术）与556名匹配的非手术对照组的5年体重减轻情况。
袖状胃切除术前服用安非他酮的患者在术后1年（8.9磅；95%置信区间[CI]，1.6 - 16.3；P = 0.02）和2年（17.6磅；95% CI，5.9 - 29.3；P = 0.003）时，手术患者与匹配对照组之间的体重差异大于服用SSRIs的患者，但5年时无差异（11.9磅；95% CI，-8.9至32.8；P = 0.26）。胃旁路术患者服用安非他酮与服用SSRIs的患者在1年（9.7磅；95% CI，2.0 - 17.4；P = 0.014）、2年（12.0磅；95% CI，-0.5至24.5；P = 0.06）和5年（4.8磅；95% CI，-16.7至26.3；P = 0.66）时的结果相似。比较服用SNRI与SSRI药物的患者未观察到显著差异。
袖状胃切除术和胃旁路术患者服用安非他酮比服用SSRIs的患者体重减轻更多，尽管这些差异可能会随时间减弱。对于考虑进行减肥手术的严重肥胖患者，安非他酮可能是首选的一线抗抑郁药。
