WLS and antidepressants

Does anyone have any experience with taking antidepressants after surgery? I am waiting to be scheduled for RNY and wondered if my dosages would need to be changed. How can you figure out if they will be absorbed differently (and need to raise the doses w/o waiting until I get depressed)? The surgeon was concerned by the number of antidepressants I was on, but this is the only combination that has consistently worked for me after years of failed attempts. Are any of you still on a number of meds after surgery and do you have trouble taking all of them?

Lizabeth Don't mess with anything. I take colorful collection every morning and evening that has taken me years to get straight. I am 4 months post and everything is still working just find. When on antidepressants you don't want to mess with what works when it works. If you do feel a change, other than a little post surgery blues, see your doctor immediately, Don't think "Oh well, I'll just level off in week or so." Take care of yourself. Good Luck!

Lisabeth: I do not have personal experience TAKING antidepressants but I know in prescribing them for post-wlsers there are a few things to consider: I would recommend AVOIDING any Sustained release meds if at all possible due to the small stomach (30cc) that has little/no acid in it to break down pills, no pyloric valve to keep it in stomach, and bypassing of differing amounts of small intestines. (*see below for limb definitions/amounts bypassed) I avoid Paxil CR (paroxetine Controlled release), Wellbutrin XL (buproprion XL), Wellbutrin SR (buproprion SR) is helpful to some, others need the Wellbutrin IR (buproprion immediate release) dosed 2-3x day. I also am careful with Effexor XR (venlafaxine SR) some are okay, others need the plain effexor (venlafaxine) dosed 2-3x day. Some decide to switch preop, others take a wait and see attitude. Vitamin/mineral deficiencies can mimic depression also (B12, B1 etc) so make sure you take vits and get labs monitored! The loss of food as you know it also leads many to a grief reaction and can add to depression, in addition to the hibernation syndrome many go through (little calories in, body conserves and gets tired!) so a time I tell my patients to stay on antidepressants FOR A YEAR postopo at LEAST! To see how things are. Some need more meds or different. It is individual. I also am careful with SSRI's with these patients due to the risk of bleeding/especially GI bleeding. In their small newly created pouch (stomach) and newly created anastomoses it could potentially add to ulcers so a Proton Pump Inhibitor or H2 blocker may help/be indicated. (2 links to articles on bleeding w/ SSRIS) **You need to register (free) to read these articles) SSRIs May Increase Risk of Gastrointestinal Bleeding http://www.medscape.com/viewarticle/448068 Selective Serotonin Reuptake Inhibitors May Increase Risk of Abnormal Bleeding http://www.medscape.com/viewarticle/494691_print http://www.aboutmso.com/pp/pp-gastricbypass.cfm a good link for explaining and pictures of the RNY bypass proximal an distal surgeries. http://www.aboutmso.com/faq/faq.cfm FROM ABOVE LINK How does the gastric bypass affect the absorption of medications? Most medications absorb normally. The exceptions to this are birth control pills, hormone replacement medication, and certain sustained release (slow release) medications. ***LIMBS DEFINED In a RNY gastric bypass there are 3 different 'limbs' of small intestines created. These 3 limbs meet at a central point (hence the Y in Roux-N-Y) The first limb they call the ROUX or ALIMENTARY/ENTERIC Limb. This is the part of the small intestine that comes off of the small surgically created ~ 15-30cc pouch. (it starts from the pouch/stoma and then gets hooked into the small intestines later on forming the Y connection (with the biliopancreatic limb) It was part of the middle small intestines (jejunum) that was cut and brought up to pouch. This limb is for transport & very little absorption of food happens here (no gastric juices/enzymes/pancreatic juices/bile etc to mix with it)***NOTE IT CAN potentially absorb LARGE quantities of basic nutrients such as amino acids and glucose without any digestive juices as Saliva alone can digest some of this. This limb is also meant to prevent reflux of digestive juices into the pouch. (*If too short reflux and complications can happen). The 2nd limb called the BILIOPANCREATIC (BP) limb is the duodenum and part of jejunum that is attached to the distal stomach (part of the stomach that is bypassed, never to see food again, but stays in person producing gastric juices) The BP limb's function is to transport ~1.5 Liters a day of bile/gastric/pancreatic juices to the "Y" CONNECTION (where the ROUX limb carrying food/vitamins/meds/fluids etc. meets this BP LIMB) it is at this Y connection that digestion/absorption of food/vits/minerals happens in the altered RNY patient..... The third LIMB is called the COMMON CHANNEL, this is the last part of the small intestines after the Y connection until the large intestines...It is the length of small intestines you have for absorption/digestion....(IF TOO SHORTexcessive malabsorbtion of nutrients/vitamins etc can happen, diarrhea...possibly requiring reoperation to save life. IN MOST (proximal) RNY gastric bypasses the Roux limb is 75 (up to150cm), the BP limb is usually 75cm leaving the common channel to be (assuming most people have 21 feet or 640 cm of small intestines) >415cm. NOW if the patient had a DISTAL (more radical but less frequently performed) gastric bypass their Common Channel is usually 100cm-150cm (40-60 inches). ~~~~~~~~~~~~~~~~~~~~~~~~ Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

My own experience has been that I have not needed to change my dosage of Zoloft. I'm 1 yr 8 months post-op, approx 123 lbs down. Not sure if I'll be losing any more. My doctor says I'm fine , and I really haven't been focusing on losing lately, either. But I'm sure everyone is different. Talk with your doctor both before and after the surgery. I'm sure your doctor will say that, just like you've done pre-surgery, post-surgery you will need to monitor how you feel and adjust if necessary. If you are taking any extended release form of medication, your doctor may want to switch you to a non-XR form, which may mean you will need to take your medication differently (possibly more than once a day, but maybe you won't need to). Just be aware of how you feel, keep the lines of communication open between you and your doctor(s), and you'll be fine! Good luck! ~~ Ilene Rachel