Answer targeted questions : PSY-Q

Dashboard

About
- Our organization
- Our people
How it works
Help
Add questions
Sign in
Sign up

Continue

Med Student
Resident
Fellow

Aggression

Antianxiety

Antidepressants

Antipsychotics

Anxiety disorders

Augmentation agents

Bipolar and related disorders

BRAIN / NNCI

Cognitive enhancers

Depressive disorders

Disorders (includes substance/medication, medical condition - induced)

Disruptive, impulse control, conduct

Dissociative disorders

Environmental - Risk/Protective Factors

Feeding and eating disorders

Gender Dysphoria

Mood stabilizers

Neurocognitive disorders

Neurodevelopmental

Non-Suicidal - Self-injurious behavior

Obsessive-compulsive and related disorders

Other High Risk Behaviors

Other mental disorders

Paraphilic disorders

Personality disorders

Psychogenomics

Psychostimulants

Schizophrenia spectrum/ other psychotic disorders

sedative-hypnotics

Sexual dysfunctions

Sleep-wake disorders

Somatic symptom and related disorders (may include pain syndromes)

Substance-related and addictive disorders

Suicidality

Trauma and stressor-related disorders

Question : 1 / 258

A 37-year-old woman with major depressive d/o and generalized anxiety d/o currently stable on sertraline 150mg daily and bupropion XL 300mg daily is scheduled for laparascopic Roux-en-Y gastric bypass. Which of the following issues should be considered in regards to her psychotropic regimen?

Bupropion should be switched to an immediate release formulation prior to surgery if feasible
Dose reduction of either or both antidepressants may be necessary post-operatively in setting of weight loss
Laparascopic banding would necessitate similar changes in regimen as Roux-en-Y
Sertraline should ideally be tapered if not discontinued in the preoperative period due to possible contribution to difficulty with weight loss postoperatively

After Roux-en-Y (in contrast to lap banding) there is significant possibility for drug malabsorption. Expert opinion suggests switching from extended to immediate release formulations if possible given these issues. There may be reduced bioavailability of SSRI and SNRI for as long as 1 year after surgery, which could require dose increase (rather than decrease). Sertraline does not have a significant enough association with weight gain to be tapered/discontinued in the acute phase, particularly in a patient who is psychiatrically stable on it.

Publication reference : Hawkins M et al. Prevalence and factors associated with psychiatric medication use in bariatric surgery candidates. Psychosomatics 2019; 60:449-457.
Reference URL: https://www.ncbi.nlm.nih.gov/pubmed/30558795
Publication reference : Roerig JL & Steffen K. Psychopharmacology and bariatric surgery. Eur Eat Disord Rev 2015; 23: 463-469.
Reference URL: https://www.ncbi.nlm.nih.gov/pubmed/26338011

Rank Med Student Resident Fellow

Rate

Dashboard

Take a quiz

Sign in

Sign up