Question:
Has anyone had problems with absorption of their psychiatric medications?

I am currently one and a half years post-op. I have been very successful with the surgery, however, I am having a lot more problems with depression and panic attacks. I have had these problems for many years, therefore, the symptoms have not occured after the surgery, they are just getting worse. I haven't had a good night sleep in about seven months. I have been trying many new anti-depressants during the past few months, since I can't seem to control my depression and anxiety well. I am currently trying Cymbalta (a very new anti-depressant). I also take Xanax for my panic disorder. Is there anyone out there that believes that you do not absorp psychiatric medications as well due to the surgery? Is there any research or other information about this? Thanks!    — Jane T. (posted on October 9, 2004)

October 9, 2004
I just had WLS on 8/25/04. I am bi-polar and take Lexapro, Lamictal, Provigil and Klonopin. The first month I took Lamictal in chewables, Lexapro in liquid and Klonopin in a dissolvable wafer. I am now taking the regular pills. Right now I can't really tell much of a difference. I asked my surgeon about the absorption of meds and he said there should be enough bowel for them to be absorbed. I have read somewhere (not sure where) that some medication dosages may have to be increased due to poor absorption after surgery. Klonopin is GREAT to help you sleep at night. I wish I could give you a definitive answer. I haven't heard of Cymbalta so I know nothing of it but I have taken about every other anti-depressant known to man over the years. It takes at least 6 weeks to see the full effect so don't be changing too often. May God bless you and keep you through this trying time. Jeanette (8/25/04 Lap RNY -35lbs) P.S. I am a Psych major at UTC. I will search our databases and see if I can find any information about absorption problems with meds. If I find something I will let you know.
   — jnetk

October 9, 2004
Hi Jane. I also suffer from depression and panic attacks and have for the past 11+ years. Next month I will be 2 years post op, and I can tell you that I have experienced problems with absorbing certain psych meds since my RNY. For example, for a several periods prior to my surgery I had trouble sleeping. So, I took chloral hydrate or Ambien and either worked great. Now, I could take the maximum dose of either and still be up all night. My psychiatrist said that it is very possible that my body simply doesn't metabolise those medications the same way. I told her that the only thing that knocks me out is Benadryl. My doctor told me to just keep taking that -- that it is non-addictive & is safe enough that pregnant & breastfeeding women can take it. So, to get my sleep I've been taking 2 Benadryls a night for the past 3+ months with no problems. If you just need a good night's sleep, check with your doctor, of course, but in my non-medical opinion, take a couple Benadryls. For me psych meds that I CAN absorb include Valium (works, but is terribly addictive), Zoloft (anti-depressant) & Buspar (anti-depressant/anti-anxiety). But that's just me, obviously, if there was a drug that worked great for everyone, we'd be spending a fortune on new clothes instead of psych visits & meds. Good luck:~)
   — klinzey

October 10, 2004
Hi Jane, I suffer from both also. All thought not all the time. This is the first since my WLS 3.5 yrs ago. I take Lexapro and Xanax. FOR ME, I realized I wasn't absorbing the Lexapro. AFter about 8 hrs. I was bottoming out big time and in major crisis. I thought if I need vitamins 3x a day instead of 1 what about my meds. Right now I'm on Lexapro 2x day and it seems to be fine. The Xanax I need 1/2 tablet every 3 hrs. I think I metabolize a whole tablet much faster than every 6. So, while the dosage is the same on the Xanax I take it more frequently. My Dr. said I can take Lexapro 30 mg a day has been proven safe-if I needed it I can go 2 3x per day but so far I'm seeing a huge improvment on 2x. I haven't felt like this in about 10 monthS!!!!! Please remember this is my experience but I'd check with your Dr.
   — Linda M.

October 10, 2004
I can't talk about meds but I do understand depression after surgery. We all have to remember that we used food to cover our emotions. Now that we can't eat HOW DO WE DEAL WITH THE EMOTIONS. I strongly recommend that everyone who has bypass surgery seek counseling of some sort (short or long) to deal with the emotional issue that will occur resulting from this surgery. Issues that come up range from; body image, marriage, dating, food, sexual abuse, etc. These are all issues that we covered with food, but we no longer have this crutch. Meds are helpful, but we need to develop coping skills.
   — Linda R.

October 10, 2004
Hi Jane, I've had a panic disorder for many years. I've found that after WLS the older tricyclic antidepressant imipramine works fantastic for me. I take it at night and don't have any problems at all with panic attacks. I also take oxazepam - a very mild tranquilizer. It is in a capsule form, so I open it, dump the contents, add a little water and stir it up. Works like a charm. Good luck with this - having panic attacks and depression aren't necessary! I think you might just have to do a little experiementing until you find what works. This combo works great for me.
   — mriley

October 10, 2004
I had to increase my Celexa from 60mg to 70mg at about 9 months PO. It took that long to fully realize I wasn't as controlled as I used to be for depression. I started noticing some changes around 6 months PO, but did not attribute it to a lack of Celexa. Adding the 10mg has made a huge difference. I also have a daytime sleep disorder that I take Provigil for and then supplement 2-3 times through the day with small doses of Ritalin. I have found my Ritalin doses usually need to go from 5mg to 10mg in order to have the same effect it used to. Since I do not have any side effects indicating I'm being overmedicated, I assume I have found the levels I absorb. Just make sure that any changes you do are with your prescribing doctor's knowledge and approval. It is critical they know what you are doing in case soomething would backfire. Good Luck!
   — zoedogcbr