A study conducted in Brazil and presented at a poster session at the 2014 annual meeting of the International Federation for the Surgery of Obesity and Metabolic Disorders looked at six cases in which patients committed suicide or attempted suicide after bariatric surgery. The study did not specify the form of weight loss surgery that each patient underwent.
Three of the six patients who underwent the surgery had an anxiety disorder and had previous psychiatric treatment, a fact that needs to be given consideration, said Sean Wharton, MD, PharmD, FRCP(C), medical director of the Wharton Medical Clinic, internist at Toronto East General Hospital in Toronto, Ontario, Canada, and Hamilton Health Sciences in Hamilton, Canada, and an adjunct professor at York University in Toronto, who was not involved with the study.
The study investigators noted that the patients had psychological follow-up until the third month after their operations. They also noted that all but one patient committed or attempted suicide one year after surgery, which led them to conclude the surgery does not immediately spur patients to an act of suicide.
“They absolutely need follow-up care for their psychiatric illness,” Dr. Wharton told General Surgery News. “They will need long-term follow-up for their psychiatric illness. Their psychiatric illness does not go away after [bariatric] surgery.”
The research suggested that patients who seek bariatric surgery have a greater burden of psychiatric illness than obese patients who do not choose the surgery. Dr. Wharton stressed that patients should not discontinue their psychiatric medications before or after surgery.
Many mood-stabilizing therapies that psychiatric patients are exposed to produce the undesirable side effect of weight gain, but newer pharmacologic therapies have been designed to have a weight-neutral effect on patients, he said.
Clinicians should favor initiation of weight-neutral medication in their newly diagnosed psychiatric patients and may consider switching to a weight-neutral medication in patients whose psychiatric illness is well controlled, said Dr. Wharton. A preferred strategy, however, would be to maintain psychiatric patients on their medication if they are stabilized, and treat the associated weight gain with lifestyle interventions like dietary modification and exercise.
Surgical centers should ensure that psychiatric patients who opt for bariatric surgery are seen by a mental health care professional, added Dr. Wharton.