Psychiatric Management of Bariatric Surgery Patients: A Review of Psychopharmacological and Psychological Treatments and their Impact on Post-Operative Mental Health and Weight Outcomes

Abstract Background Bariatric surgery is an effective treatment for severe obesity; however, high rates of psychiatric comorbidity complicate bariatric surgery care. As a result, importance has been placed on the need for ongoing psychiatric support in bariatric surgery patients. Given the lack of conclusive pre-surgery psychosocial predictors of post-operative mental health outcomes, studies have now shifted their focus to understand the long-term psychosocial sequalae that arise post-surgery. Increasing evidence has demonstrated the potential for psychiatric care to stabilize psychiatric symptoms and minimize patient distress. Objective To review psychopharmacological and psychological interventions for bariatric surgery patients and their impact on mental health and weight outcomes post-surgery. Methods We performed a comprehensive literature search in OVID Medline for studies examining the impact of psychopharmacological and psychological treatments on bariatric patients’ post-operative mental health and weight outcomes. Results Overall, 37 studies were included in the review. Preliminary evidence suggests that psychiatric medications do not negatively impact weight loss or health-related quality of life in the short-term; however, more rigorous research designs are needed. There is insufficient data on specific psychiatric medications and long-term impact on weight loss and psychosocial outcomes. Post-operative psychological interventions have evidence for improving eating psychopathology, anxiety, and depressive symptoms; however, effects on weight loss remain unclear. Conclusion Evidence for psychopharmacological and psychological treatments remains preliminary. Consideration should be given to integrated, stepped-care models to provide personalized psychiatric interventions post-surgery. Future research on expanding current psychiatric interventions, timing of delivery, and predictors of response is needed.