SSRI monotherapy impacts weight loss outcomes following bariatric surgery

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for anxiety and depression among patients undergoing metabolic and bariatric surgery (MBS). SSRIs are associated with weight gain in the general population, and therefore may potentially hinder weight loss post-bariatric surgery. This study evaluated the effect of continued SSRI monotherapy on weight loss outcomes following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

A retrospective cohort study of adults who underwent SG or RYGB between July 2020 and June 2023 was conducted. Patients with depression or anxiety receiving SSRI monotherapy before surgery and continuing treatment for at least 12 months postoperatively were compared with patients without depression or anxiety by surgical procedure. Propensity-score matching was performed in a 1:1 ratio using demographic and clinical variables. Primary outcomes were total weight loss percentage (TWL%) and excess weight loss percentage (EWL%) at 3, 6, and 12 months.

Among 799 patients, 731 were included in the no anxiety/depression (No A/D) group and 68 in the anxiety/depression with SSRI monotherapy (A/D SSRI) group. Unadjusted analyses demonstrated no significant differences in TWL% or EWL% between groups in either procedural cohort. Following propensity-score matching, patients undergoing SG in the A/D SSRI group achieved significantly lower EWL% at 3 months (32.5 vs. 42.8%, p = 0.035) and 12 months (47.3 vs. 63.5%, p < 0.001), as well as lower TWL% at 3 months (15.1 vs. 20.0%, p = 0.015) and 12 months (22.4 vs. 28.5%, p = 0.034). No significant differences in TWL% or EWL% were observed at any time point among patients undergoing RYGB (p > 0.274).

Continued SSRI monotherapy may be associated with inferior short- and intermediate-term weight loss following sleeve gastrectomy, but does not appear to adversely affect weight loss after Roux-en-Y gastric bypass. These findings may inform preoperative counseling, procedure selection, and postoperative management of bariatric patients receiving SSRI therapy.