Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Route de Cery 11b, CH-1008, Prilly, Switzerland.
Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
Obes Surg. 2023 May;33(5):1422-1430. doi: 10.1007/s11695-023-06526-1. Epub 2023 Mar 22.
Roux-en-Y gastric bypass (RYGB) involves alterations of the gastrointestinal tract resulting in altered absorption. Patients with obesity have a higher prevalence of depression, and antidepressants are often prescribed. Alterations caused by RYGB could modify drug bioavailability and cause potential subtherapeutic plasma concentrations, increasing the risk of depressive relapse. The aim of this study was to describe the evolution of trough drug dose-normalized antidepressant plasma concentrations before and after RYGB.
This naturalistic prospective case series considers patients with trough plasma concentrations in a 1-year timeframe before and after RYGB. Only antidepressants prescribed to at least three patients were included in the present study.
Thirteen patients (n = 12 females, median age 44 years, median BMI before intervention = 41.3 kg/m) were included. Two patients were treated concurrently with fluoxetine and trazodone; the remaining patients were all treated with antidepressant monotherapy. Therapeutic drug monitoring (TDM) values for duloxetine (n = 3), escitalopram (n = 4), fluoxetine (n = 4), and trazodone (n = 4) before (median 4.7 weeks) and after (median 21.3 weeks) RYGB intervention were analyzed. Compared to preintervention, median [interquartile range] decreases in dose-normalized trough plasma concentrations for duloxetine (33% [- 47; - 23]), escitalopram (43% [- 51; - 31]), fluoxetine (9% [- 20; 0.2]), and trazodone (16% [- 29; 0.3]) were observed.
This study shows a decrease in plasma antidepressant concentrations following RYGB. TDM before and after RYGB, in addition to close monitoring of psychiatric symptomatology, may help optimize antidepressant treatment after bariatric surgery. These results also highlight the need for prospective studies assessing the clinical evidence available through TDM in these patients.
Roux-en-Y 胃旁路术（RYGB）涉及胃肠道的改变，导致吸收改变。肥胖患者的抑郁症患病率较高，经常开抗抑郁药。RYGB 引起的改变可能会改变药物的生物利用度，并导致潜在的治疗性血浆浓度降低，增加抑郁复发的风险。本研究旨在描述 RYGB 前后药物谷浓度标准化抗抑郁药血浆浓度的变化。
本自然前瞻性病例系列研究考虑了 RYGB 前后 1 年时间内的药物谷浓度。只有至少有 3 名患者开的抗抑郁药才包括在本研究中。
共纳入 13 名患者（n=12 名女性，中位年龄 44 岁，干预前中位 BMI 为 41.3kg/m）。2 名患者同时服用氟西汀和曲唑酮；其余患者均接受单药抗抑郁治疗。分析了 3 名患者服用度洛西汀（n=3）、4 名患者服用依西酞普兰（n=4）、4 名患者服用氟西汀（n=4）和 4 名患者服用曲唑酮（n=4）的治疗药物监测（TDM）值，分别在 RYGB 干预前（中位 4.7 周）和干预后（中位 21.3 周）。与干预前相比，度洛西汀（33%[-47；-23]）、依西酞普兰（43%[-51；-31]）、氟西汀（9%[-20；0.2]）和曲唑酮（16%[-29；0.3]）的剂量标准化谷浓度中位数均下降。
本研究表明 RYGB 后血浆抗抑郁药浓度降低。RYGB 前后的 TDM，加上对精神症状的密切监测，可能有助于优化肥胖手术后的抗抑郁治疗。这些结果还强调需要进行前瞻性研究，评估这些患者通过 TDM 获得的临床证据。
