PLEASE make sure you are getting levels checked more often for anyone on Depakote, Lithium salts. WLS not only affects the absorption of some minerals, but also with the changes in body chemistry autonomic and sympathetic systems can be affected by slight changes.  Meds that worked before may need to be re-evaluated. Hang in there. Chart your changes in cycling and discuss with your doc. Also helpful to  note any new or changing stressors.

Best of luck-

this was posted on Rny board by puggy dawn

Post Date: 12/17/08 2:36 pm
Large numbers of Roux-en-Y gastric bypass (RYGB) surgery patients have psychiatric illnesses that are in part treated with medications preoperatively, but there are no objective data to guide psychiatric drug dosing postoperatively.An in vitro dissolution model was developed to approximate the gastrointestinal environment of the preoperative (control) and post-RYGB states.Medication tablets were placed in the two environments, and the median calculated weights of the dissolved portions were compared.Ten of 22 psychiatric medication preparations had significantly less dissolution and two had significantly greater dissolution in the post-RYGB environment, compared with the control environment.The results suggest a need for an in vivo study of serum drug levels after RYGB surgery in patients taking psychiatric medications.Differences in the pharmacokinetics of the postoperative RYGB patient may necessitate adjustments in dosing. (Psychosomatics 2005; 46:250-253) 

This has beend edited the following table to (a) make it easier to read, (b) to use brand names rather than generics, and (c) be reflective of the more commonly used meds.Please see the cited article, here, to view the table in its original form. Please remember that this study used modeled environments.The study authors used crushed and immediate release formulas of these medications.PLEASE, remember, that extended release versions of psych meds behave totally differently, and really should not be used in a person with an RNY (this is being said by the author of the article~ not myself ~ PuggyDawn).Remember also, that you may not see the effects of decreased bioavailability for several weeks postop, as the half lives for some of these meds can be quite long.I encourage you to use this data to open a dialog with your psychiatric provider. As you can see from the table, the amount of dissolved medication is higher in the preop environment for Prozac, Paxil, and Zoloft.Effexor and Celexa are pretty much the same for both environments.Wellbutrin, oddly enough, appears to have a higher amount of dissolved medication in the post-RYGB environment.The anti-anxiety/sedatives don’t have much difference between environments.The atypical antipsychotics, however, do show differences.Seroquel has the most difference between pre and post op (I can definitely speak to that—I’ve had to almost double my dose), with Geodon right behind.Risperdal and Zyprexa do show a difference as well.Lithium has increased amount of dissolved med in the post-op model, which makes me wonder about how ones lithium levels would be effected. Please check out the article, cited here.Thanks to the author for allowing me to use it J Table 1.Weights of Dissolved Portions of Psychiatric Medications in Standardized Dissolution Test Models of the Gastrointestinal Environments of Preoperative and Postoperative Roux-en-Y Gastric Bypass (RYGB) Patients.

		Median weight of	Median weight of
Medication	Dose (mg/day)	Dissolved portion (mg)--Pre-Op	Dissolved portion (mg)-Post-Op
Antidepressants
Prozac	20mg	110	40
Paxil	20mg	30	10
Zoloft	100mg	50	30
Wellbutrin	100mg	320	450
Effexor	75mg	180	180
Celexa	20	70	80
Anti-anxiety/Sedatives
Klonopin	0.5mg	100	90
Buspar	10mg	120	120
Valium	5mg	10	10
Ativan	1mg	10	0
Trazodone	100mg	330	330
Ambien	5mg	100	90
Atypical Antipsychotics
Zyprexa	10mg	190	160
Seroquel	200mg	270	120
Risperdal	2mg	130	100
Geodon	80mg	280	210
Mood Stabilizers
Lithium	300mg	130	280
Trileptal	300mg	20	10

I don't know why you think your body will not absorb it after surgery...I am bipolar and have taken my meds everyday..even the day of surgery and there had to be some adjustments but I absorb them fine.

I used to take Trazadone to help me sleep...but it always gave me like a "hang over" feeling in the mornings..so my doc changed me to ambien..but I take Trileptal, Pristqe and abilify for my bipolar.

There is actually a chart that shows that some people absorb more of their depression medication and the dose has to be cut back..so not everyone malabsorbs...

Cymbalta and Pristqe were too new of a medication to be included in this chart..but I hope it helps....

Dawn

I am just realizing that my relapses with alcohol might be attributed to my bipolar being off since my surgery.  It just never occurred to me that malabsorption might be part of my problem.  I need to discuss this with my psychiatrist.

Malabsorption issues are part of that problem with bypass surgery patients.  That is why the need for vitamins and minerals and I get B12 shots because of it.

Talking to your psychiatrist is the best route to take.

Trish

Well, my Eagles have to go to Arizona and, again, they are the underdogs.  They were 3 point underdogs in New York on Sunday.  We shall see if they can pull this one off.  I was ready to say, "Stick a fork in 'em, they are done,"  about the middle of November.

Take care....Go Eagles. 

Hugs,
Trish

anytime......