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Background <p>Depression affects up to half of bariatric surgery candidates, yet the impact of depression severity and preoperative antidepressant pharmacotherapy use on surgical outcomes remains poorly characterized.</p> Methods <p>This was a retrospective cohort study of patients who underwent primary minimally invasive sleeve gastrectomy or Roux-en-Y gastric bypass at a single institution between January 2018 and June 2024. Depression severity was stratified using PHQ-9 scores obtained during standard preoperative psychological evaluation. Antidepressant use was classified by pharmacologic class and number of concurrent medications. The primary outcome was percent excess body weight loss (%EBWL) at 6, 12, 24, 36, 48, and 60&#xa0;months postoperatively. Secondary outcomes included 30-day perioperative complications, readmissions, and emergency department visits.</p> Results <p>Of 930 patients identified, 128 (13.8%) carried a preoperative depression diagnosis. Patients with depression achieved significantly greater %EBWL at 6&#xa0;months (46.9% vs. 43.1%, <i>p</i> = 0.026), 1&#xa0;year (56.9% vs. 52.0%, <i>p</i> = 0.012), and 2&#xa0;years (59.0% vs. 50.4%, <i>p</i> = 0.007) compared to those without depression, with no significant differences at later timepoints. Among patients with depression, those with none/minimal PHQ-9 severity had significantly greater %EBWL at 1&#xa0;year compared to mild/moderate and moderately severe/severe groups (<i>p</i> = 0.031). No significant differences in 30-day perioperative complications were observed based on depression diagnosis or PHQ-9 severity category. However, patients with depression who were not taking antidepressants had significantly higher overall complication rates (11.5% vs. 0%, <i>p</i> = 0.002) and 30-day readmission rates (15.4% vs. 3.0%, <i>p</i> = 0.045) compared to those receiving antidepressant therapy.</p> Conclusions <p>Preoperative depression is not a contraindication to bariatric surgery; patients with depression can achieve excellent short-term weight loss, particularly in the first two postoperative years. Optimizing preoperative depression treatment appears to reduce perioperative morbidity and may confer a protective effect on perioperative outcomes in this population.</p>

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Impact of preoperative depression severity and antidepressant medication use on perioperative outcomes and long-term weight loss following primary bariatric surgery

  • 期刊论文

  • 发表日期：

    2026年7月9日

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  • Emil Maric,
  • Colin Wang,
  • Selma Zukancic,
  • Kristine Kuchta,
  • Julia R. Amundson,
  • Ashley Rolnik,
  • Herbert Mason Hedberg,
  • John Linn,
  • Ervin Woody Denham,
  • Michael Ujiki,
  • Natalie Liu

摘要

Background

Depression affects up to half of bariatric surgery candidates, yet the impact of depression severity and preoperative antidepressant pharmacotherapy use on surgical outcomes remains poorly characterized.

Methods

This was a retrospective cohort study of patients who underwent primary minimally invasive sleeve gastrectomy or Roux-en-Y gastric bypass at a single institution between January 2018 and June 2024. Depression severity was stratified using PHQ-9 scores obtained during standard preoperative psychological evaluation. Antidepressant use was classified by pharmacologic class and number of concurrent medications. The primary outcome was percent excess body weight loss (%EBWL) at 6, 12, 24, 36, 48, and 60 months postoperatively. Secondary outcomes included 30-day perioperative complications, readmissions, and emergency department visits.

Results

Of 930 patients identified, 128 (13.8%) carried a preoperative depression diagnosis. Patients with depression achieved significantly greater %EBWL at 6 months (46.9% vs. 43.1%, p = 0.026), 1 year (56.9% vs. 52.0%, p = 0.012), and 2 years (59.0% vs. 50.4%, p = 0.007) compared to those without depression, with no significant differences at later timepoints. Among patients with depression, those with none/minimal PHQ-9 severity had significantly greater %EBWL at 1 year compared to mild/moderate and moderately severe/severe groups (p = 0.031). No significant differences in 30-day perioperative complications were observed based on depression diagnosis or PHQ-9 severity category. However, patients with depression who were not taking antidepressants had significantly higher overall complication rates (11.5% vs. 0%, p = 0.002) and 30-day readmission rates (15.4% vs. 3.0%, p = 0.045) compared to those receiving antidepressant therapy.

Conclusions

Preoperative depression is not a contraindication to bariatric surgery; patients with depression can achieve excellent short-term weight loss, particularly in the first two postoperative years. Optimizing preoperative depression treatment appears to reduce perioperative morbidity and may confer a protective effect on perioperative outcomes in this population.