From the Research
After gastric bypass surgery, psychiatric medication dosing often needs to be adjusted to prevent adverse effects and ensure therapeutic efficacy, with a focus on reducing dosages by 20-50% in the weeks following surgery and closely monitoring blood levels and mental health symptoms 1.
Key Recommendations
- Consult with both your psychiatrist and bariatric surgeon to develop a personalized plan, taking into account the altered digestive system and potential changes in medication absorption and metabolism.
- Expect to reduce dosages of most psychiatric medications by 20-50% in the weeks following surgery, as the reduced stomach size and changed intestinal absorption can lead to unpredictable drug levels.
- Monitor blood levels of medications like lithium and valproic acid more frequently, as absorption can be unpredictable, and adjust dosages accordingly.
- Switch extended-release formulations to immediate-release versions initially, as the altered digestive tract may affect drug absorption, and consider alternative delivery methods like liquid formulations or crushed tablets if swallowing pills is difficult.
- Be vigilant for side effects or changes in mental health, as medication effectiveness may change, and gradually adjust dosages back up if needed, based on symptoms and blood levels.
Rationale
The adjustments are necessary because gastric bypass alters the digestive system, potentially affecting how medications are absorbed and metabolized, and weight loss itself can impact how the body processes medications, leading to changes in medication efficacy and potential adverse effects 1, 2.
Considerations
It is essential to prioritize close monitoring and a flexible approach to maintain mental health stability while adapting to the post-surgical changes, and to consider the potential impact of substance use disorders on medication management and overall health outcomes 2.