Schaefer Matthew, Garrote Fabio, Junquera Patricia
Neurosurgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Anesthesiology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Cureus. 2024 Mar 18;16(3):e56373. doi: 10.7759/cureus.56373. eCollection 2024 Mar.
Bariatric surgery is a commonly performed procedure for patients who have failed to achieve weight loss through medical and lifestyle interventions. However, the altered gastrointestinal anatomy resulting from the surgery can significantly impact the bioavailability of antidepressants in patients with generalized anxiety disorder, potentially leading to uncontrolled anxiety symptoms. This case report describes a patient with generalized anxiety disorder who underwent Roux-en-Y gastric bypass surgery and subsequently experienced increased anxiety symptoms due to poor antidepressant bioavailability. The patient's medication was adjusted to a sublingual formulation, resulting in improved anxiety control and reduced side effects. Healthcare providers should be aware of the potential impact of bariatric surgery on medication absorption and closely monitor patients with generalized anxiety disorder for potential psychiatric medication-related complications postoperatively. The use of alternative routes of administration, such as sublingual medication, may be beneficial in improving drug bioavailability and managing anxiety symptoms. Creating awareness in primary care offices about poor drug absorption and using alternatives such as the sublingual route of administration to achieve optimal systemic delivery requires a multifaceted approach involving education and training for healthcare providers as well as patient education to ensure they are informed and engaged in their own care. By implementing these strategies, primary care providers can improve patient outcomes and prevent unnecessary referrals to specialists.
对于那些通过医学和生活方式干预未能实现体重减轻的患者，减肥手术是一种常见的治疗手段。然而，手术导致的胃肠道解剖结构改变会显著影响广泛性焦虑症患者体内抗抑郁药的生物利用度，进而可能导致焦虑症状无法得到控制。本病例报告描述了一名广泛性焦虑症患者，该患者接受了胃旁路手术（Roux-en-Y），随后因抗抑郁药生物利用度不佳而出现焦虑症状加重的情况。对该患者的用药进行了调整，采用舌下给药制剂，从而改善了焦虑症状的控制并减少了副作用。医疗服务提供者应意识到减肥手术对药物吸收的潜在影响，并密切监测广泛性焦虑症患者术后是否可能出现与精神科用药相关的并发症。采用替代给药途径，如舌下给药，可能有助于提高药物生物利用度并控制焦虑症状。要在基层医疗诊所提高对药物吸收不良的认识，并使用舌下给药等替代途径来实现最佳的全身给药效果，需要采取多方面的措施，包括对医疗服务提供者进行教育和培训以及对患者进行教育，以确保他们了解相关情况并积极参与自身的治疗。通过实施这些策略，基层医疗服务提供者可以改善患者的治疗效果，并避免不必要地转诊至专科医生处。
