Question:
Anyone told they can't take antidepressants post RNY (prox)

I was told by my Drs. office that I would not be sent home on any of my antidepressants (I'm on three) When I asked why, the nurse said, "well people don't need their blood pressure meds." "They don't need their diabeties meds anymore"... The nurse seemed to believe that the surgery would take care of all those issues, but I have needed these meds even when I weighed 130 lbs. Any thoughts?    — Cindi W. (posted on March 21, 2000)

March 21, 2000
I would not advise going off your meds like this. I take Zoloft for depression, and have for years. I was terribly concerned that I would have a bad post-op depression, and my doctor said I should start taking my Zoloft again as soon as I could swallow the pills after surgery. As of day 3 in the hospital, I started taking the Zoloft again, and have not had any depression. I did find that the Zoloft irritates my pouch, even now after six months. I can take it with milk or crackers and that reduces the irritation. I would suggest talking to the doctor who prescribed these anti-depressants for you. He/She may be able to advise your surgeon on what is best for you in this instance.
   — Lynn K.

March 21, 2000
Though it is true that many people do not need to take medications for hypertension or diabetes after WLS, antidepressants are not the same type of drug nor do they treat a physical illness. Many antidepressants work by building up a certain blood concentration and it would be imprudent to withdraw from these types of drugs "cold turkey" It could actually set up problems after surgery due to a suddden change and absence of medication. Although many people do not continue to take antidepressants after WLS (which may be due to the positive and euphoric feelings after surgery) depressin is also a disease of cemical imbalances and so it is not always cured by situational changes. Better be careful about discontinuing any medications after weight loss surgery. Would it be ideal for the doctor who prescribed the original medication to be consulted on the absorption rates and medical necessity of medications after WLS?
   — Fran B.

March 21, 2000
I ran across this from a packet of info I received on WLS ..It pertains to expected side affects of RNY. <p> Mineral absorption <p> the lower part of the stomach and the upper (proximal) part of the small intestine do not participate in the digestion of food after a Gastric Bypass because they are (you guessed it) bypassed. They play an important part in the absorption of some minerals (Iron, Calcium, and to a lesser extent Magnesium) and vitamins (Vitamin B12 and to a lesser extent B6). In our practice, patients who have had a Gastric Bypass need to take Multivitamins with Iron, and supplemental Calcium (usually TUMS) every day for life. Up to 1/4 of patients also require supplemental B12, which is given as a shot once each month. Rarely, patients cannot keep up their Iron stores by oral supplements and they need intravenous Iron therapy. <p> Lactose intolerance <p> lactose ("milk sugar") is a particular type of sugar found in milk and dairy products. Absorption of lactose requires a particular enzyme that is mostly found in the bypassed segment of intestine. Thus, many of our patients who did well with milk before surgery find that after Gastric Bypass dairy products cause abdominal cramping and flatulence. This can be treated by Lactaid, which is an over-the-counter enzyme supplement. The bowel also tends to adapt over time and this is less of a problem in most patients 6 months after surgery. <p> "Hibernation syndrome" <p> two or three weeks after Gastric Bypass, the patient's body "figures out" that it is not going to be receiving its accustomed calories for a long time. In about half of our patients this results in what we call the hibernation syndrome, where one's body falls back on its built-in evolutionary response to a low food supply - the person just wants to rest and be as still as possible until the food returns. Energy level drops through the floor, and the individual can become emotionally labile (tearful or irritable). There can also be a component of depression caused by the loss of the previous relationship with food. This syndrome can be unnerving for patients because it comes at a time when they are just beginning to get over the pain and other effects of surgery - they believe they should be feeling better but they just want to curl up and go to sleep. The good news is that this is not a dangerous or unusual thing, and will resolve in about 2 weeks when the body figures out how to use fat as its main energy source. <p> Hair loss <p> most patients notice some increase in hair loss about 3 months following surgery. For some patients the amount of hair loss is dramatic - they describe clumps of hair in their brush, hair covering the floor of the shower, etc. This occurs as part of the body's response to sudden calorie and protein deprivation just after surgery. The body puts some of its normal maintenance activities "on hold" until nutrition is coming in again, and the effects take a few months to show up. In fact, nothing actually happens to the hair follicles, and at the time the hair loss is noticed the follicles are probably busy regenerating hair. It is rare for patients to have thinner hair one year after surgery than what they began with. Most physicians advise their patients to maximize their protein intake to prevent or treat hair loss. We also emphasize that food that the patient eats should focus on protein (don't "waste space" on non-protein calories) but we stop short of pushing a specific protein goal because of the following: The most effective way to increase protein intake is to eat more frequently (in fact, many dieticians erroneously advise bariatric patients to eat 8-10 small meals per day). Frequent eating is the only way to "defeat" the calorie restriction of a surgically intact gastric bypass - it is possible to "graze" your way to a calorie intake that will keep you from losing weight. The capacity of the pouch and small intestine are so small that patients lose weight no matter how frequently they eat for the first couple of months, but the capacity naturally increases over a period of months so that if bad habits (eating frequently) are established, then long term weight loss will not proceed as far as it could. We advise patients to eat 3-4 meals per day (not more) and to concentrate on healthy food - adequate protein intake will come naturally if they comply with these simple rules. <p> Excess skin <p> unfortunately, the skin that holds all of your fat tissue before the surgery tends not to shrink down as the fat goes away. Most patients are left with large floppy areas of skin, especially on the abdomen, upper arms, thighs, and breasts. Exercise is very important for the patient's overall success, but it is not very effective in causing shrinkage of skin. Actual removal of the skin by plastic surgery is frequently desirable, although most insurance companies view this as cosmetic surgery in the vast majority of patients (we don't share this opinion). Translation: "cosmetic" = we won't pay for it. We recommend that our patients wait at least one year following the gastric bypass to undergo surgery for removal of excess skin. This delay is because the skin surgery works best for the long term if it is done when you are at a stable weight - it's disappointing and counterproductive to undergo surgery and then develop more flabby skin as weight loss progresses. We also feel more confident that patients are nutritionally up to surgery when their weight is stable. On a humorous but practical note, if a patient puts aside all the money saved in grocery bills after gastric bypass, she will actually have enough saved to pay for a tummy tuck at about the time they are medically ready for it - store the money in a cookie jar. :-) <p> Gallstones <p> cycles of weight loss and weight gain predispose to formation of gallstones, so many patients who undergo bariatric surgery have already had their gallbladders removed. For patients who still have their gallbladder, we will check it during the operation and if we find stones we will plan to remove it. If the patient's gallbladder is normal we will leave it alone - there is some risk of forming gallstones as a result of the weight loss after gastric bypass so we will ask you to take Actigall (a bile thinning medicine) for six months after surgery. Marital and Relationship distress - every interpersonal relationship in which the patient participates will change substantially as the dramatic weight loss occurs. This change will affect all relationships, but the marital relationship is one of the most significant - a very high percentage of patients get divorced within the first two years after weight loss surgery. The patient generally becomes more outgoing and socially involved as weight loss progresses; in some cases the patient desires to leave the marriage and in other cases this creates a crisis in confidence for the spouse. We do not have a solution to this problem, except to strongly encourage patients and their loved ones to consider the upcoming stress before surgery. If the marriage is not a strong one, the couple should engage in marriage counseling before the weight loss surgery. Other interpersonal relationships can experience unexpected changes as well - more than one mother or child of a patient has expressed regret over the loss of the person they knew.... <p> Other side effects? <p> the good news on the Roux-en-Y Gastric bypass is that it has been in use since the late 1960's, so there are not likely to be any "surprise" side effects yet to be discovered. That's not to say that the above list is completely exhaustive, but this discussion plus the ensuing discussion of surgical risk covers the high points.
   — Victoria B.

March 21, 2000
Please check with your Dr. The person that told you that must not be a Nurse. I can't imagine anyone with any medical knowledge saying that. As a matter of fact, my surgeon is going to put me on Prozac prior to surgery to help with an unforseen depression from lack of food I've had a relationship to for so long. Prozac because of the seritona effect and because it comes in liquid. Good Luck
   — CohenHeart

March 22, 2000
Oops, thanks Roberta for clarifying my answer about depression. You are right when you say that I didn't mean to imply that depression wasn't a physical illness. I thought when I added about it being a chemical imbalance that would have pointed to physical illness. Thanks :-o I have been treated for depression for many years and have taken quite hefty doses of Paxil at different times in my life. I did start to wean off the antidepressant prior to my surgery; truly just the anticipation that the operation WAS going to happen did give me a better outlook. After the surgery, I find that I do have a better outlook and am taking a minimal dose of Paxil now. I do hope to be able to get off this medication altogether but if not, I'm okay with that. The surgery has already gotten me off my medications for diabetes, hypertension, high cholesterol, C-Pap machine, and that is nothing to sneeze at!
   — Fran B.

March 22, 2000
I think that almost all WLS patients should be restarted on their preoperative antidepressants as soon as possible, unless there is a medically compelling reason not to do so. There is ample documentation of severe post-operative depression in WLS patients despite being non-depressed before surgery. It is possible that antidepressants can be weaned from a WLS patient "down the road," but psychiatrists I have consulted think they should be reinstitued as soon as the patient can take the medication (especially those that come in liquid form such as Paxil and Prozac, etc.)
   — Heddy-Dale M.

April 15, 2000
That's ridiculous, you should still take your anti-depressants, those kinds of pills can't just be stopped all of a sudden anyways. I brought my pills to the hospital in my bag and took them myself. There should be no problem taking them I didn't have any problems. I took them without telling anyone except my psychiatrist. I suggest you still take them, they have nothing to do with the surgery medically. You can't have any complications from them. I had a hard time adjusting mentally after surgery, only briefly though until I healed and I can't imagine dealing with everything without the aintidepressants in my system!!!
   — Lara G.