Pasi Patrick, Kröll Dino, Siegfried Alena, Sykora Martin, Wildisen Alessandro, Milone Cristiana, Milos Gabriella, Horka Laura, Fischli Stefan, Henzen Christoph
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
Division of Visceral Surgery, University Hospital Bern, University of Bern, Bern, Switzerland.
Front Psychiatry. 2023 Apr 25;14:1132112. doi: 10.3389/fpsyt.2023.1132112. eCollection 2023.
Depression and treatment with antidepressants SSRI/SNRI are common in people with morbid obesity who are candidates for bariatric surgery. There is few and inconsistent data about the postoperative plasma concentrations of SSRI/SNRI. The aims of our study were to provide comprehensive data about the postoperative bioavailability of SSRI/SNRI, and the clinical effects on depressive symptoms.
Prospective multicenter study including 63 patients with morbid obesity and therapy with fixed doses of SSRI/SNRI: participants filled the Beck Depression Inventory (BDI) questionnaire, and plasma levels of SSRI/SNRI were measured by HPLC, preoperatively (T0), and 4 weeks (T1) and 6 months (T2) postoperatively.
The plasma concentrations of SSRI/SNRI dropped significantly in the bariatric surgery group from T0 to T2 by 24.7% (95% confidence interval [CI], -36.8 to -16.6, = 0.0027): from T0 to T1 by 10.5% (95% 17 CI, -22.7 to -2.3; = 0.016), and from T1 to T2 by 12.8% (95% CI, -29.3 to 3.5, = 0.123), respectively.There was no significant change in the BDI score during follow-up (-2.9, 95% CI, -7.4 to 1.0; = 0.13).The clinical outcome with respect to SSRI/SNRI plasma concentrations, weight change, and change of BDI score were similar in the subgroups undergoing gastric bypass surgery and sleeve gastrectomy, respectively. In the conservative group the plasma concentrations of SSRI/SNRI remained unchanged throughout the 6 months follow-up (-14.7, 95% CI, -32.6 to 1.7; = 0.076).
In patients undergoing bariatric surgery plasma concentrations of SSRI/SNRI decrease significantly by about 25% mainly during the first 4 weeks postoperatively with wide individual variation, but without correlation to the severity of depression or weight loss.
抑郁症以及使用抗抑郁药选择性5-羟色胺再摄取抑制剂/5-羟色胺-去甲肾上腺素再摄取抑制剂（SSRI/SNRI）进行治疗，在病态肥胖且适合进行减肥手术的人群中很常见。关于术后SSRI/SNRI的血浆浓度，数据稀少且不一致。我们研究的目的是提供关于术后SSRI/SNRI生物利用度以及对抑郁症状临床影响的全面数据。
前瞻性多中心研究，纳入63例病态肥胖且接受固定剂量SSRI/SNRI治疗的患者：参与者填写贝克抑郁量表（BDI）问卷，并通过高效液相色谱法（HPLC）在术前（T0）、术后4周（T1）和6个月（T2）测量SSRI/SNRI的血浆水平。
减肥手术组中，SSRI/SNRI的血浆浓度从T0到T2显著下降了24.7%（95%置信区间[CI]，-36.8至-16.6，P = 0.0027）；从T0到T1下降了10.5%（95% CI，-22.7至-2.3；P = 0.016），从T1到T2下降了12.8%（95% CI，-29.3至3.5，P = 0.123）。随访期间BDI评分无显著变化（-2.9，95% CI，-7.4至1.0；P = 0.13）。接受胃旁路手术和袖状胃切除术的亚组中，关于SSRI/SNRI血浆浓度、体重变化和BDI评分变化的临床结果分别相似。在保守治疗组中，SSRI/SNRI的血浆浓度在6个月的随访期间保持不变（-14.7，95% CI，-32.6至1.7；P = 0.076）。
在接受减肥手术的患者中，SSRI/SNRI的血浆浓度主要在术后前4周显著下降约25%，个体差异较大，但与抑郁严重程度或体重减轻无关。
