Bipolar and Bariatric (Updated)
Bipolar and Bariatric
Bipolar sufferers not only have to deal with a lifetime of medications, Psychiatrists, Physiologists, hospitals, and the stigma of living with bipolar disorder, they also have a higher risk of obesity. "American researchers noted that people with bipolar disorder have an increased risk of obesity" (BP Magazine, 2014, p. 14). At the 2013 International Society of Bipolar Disorder, David Bond presented research about the link between bipolar disorder and obesity. He stated that, “Obese patients with bipolar disorder have more episodes of depression, more suicide attempts, worse response to psychiatric medications, and more cognitive impairment between episodes of illness” (Post, MD, 2013, p. 13).
A study published in the The American Journal of Psychiatry, sought to evaluate the connection between obesity to 175 patients with a diagnosis of bipolar I disorder. Of the 175 patients, 35.4% met obesity criteria. They found that the presence of obesity in the 175 patients (35.4%) was much higher than the 19.8% of the general U.S. Results showed that “bipolar disorder may increase the risk of obesity due to medication exposure and disease-specific symptoms that commonly occur during long-lasting depressive episode, such as increases in appetite and reduced energy expenditure” (Fagiolini, Kupfer, Houck, & Novick, n.d.). They believe that treating and preventing obesity in bipolar patients could possibly improve the course of their bipolar illness, decrease the morbidity and mortality of physical illness, and enhance psychological well-being (Fagiolini, Kupfer, Houck, & Novick, n.d.).
Over the years, severely obese patients have been found ineligible to have bariatric surgery because for their bipolar diagnosis. Doctors, Psychiatrists, and Surgeons believed that bipolar bariatric patients would have a greater risk of hospitalization and suicide. Research has shown that bariatric surgery is just as safe for a bipolar sufferer as it is for a non-bipolar bariatric patient. Ameena Ahmed, one of the study’s authors, states that, “People with stable bipolar disorder can be evaluated for bariatric surgery using the same criteria as other patients” (Piper, 2013). The study conducted consisted of 144 severely obese (average BMI at 42 kg/m²) bipolar individuals who underwent bariatric surgery. They found that “just 13 (9.0%) were admitted to a psychiatric outpatient hospital during more than 2 years of follow-up” (Piper, 2013). This was not significant compared to the 10.6% of 1140 patients who suffer from bipolar disorder and didn't have bariatric surgery. Researchers note that all bipolar bariatric patients studied, had not been hospitalized a year prior to surgery, and had no substance abuse or dependence (Piper, 2013).
Another concern that medical professionals and patients alike have, is the change in body weight and the medications effectiveness and absorption. Doctors have found that with the Roux-en-Y gastric bypass bariatric procedure and the resulting reduction of small intestines, which helps break down and digest fats and proteins, decreases time a drug absorbs and reduces the drug’s bioavailability. Also, with the gastric bypass procedure and the decrease in stomach size, there is a decrease in hydrochloric acid, which can decrease the absorption of medications dependent on acidic environments.
As with any surgery, there is the possibility of serious illness, side effects and/or possibly death. Anytime one is put under general anesthesia, there are serious risks, and one needs to weigh the benefits of the procedure with the possibility of these serious complications. When it comes to individuals diagnosed with bipolar disorder, there are certain special circumstances one must consider. Working closely with your Surgeon, Physician, Physiologist, and Psychiatrists is a must. When it comes to regulating one’s medications, you need to include your Psychiatrist in all aspects of your care. If I had to do it all over again, I would track my mood daily, and see my Psychiatrist on a more regular basis. This would have helped me avoid some of the bipolar issues that I had 10 months post-op. When making a life changing decision, be smart, know what you are getting into, know the expectations, and enjoy the ride.
References
BP Magazine. (2014, Winter). Bariatric surgery outcomes promising. BP Magazine, 10(1), 14.
Fagiolini, A., Kupfer, D., Houck, P. R., & Novick, E. I. (n.d.). Obesity as a correlate of outcome in patients with bipolar I. The American Journal of Psychiatry, 160(1), 112-117. Retrieved from ProQuest 5000 database. (Accession No. 220143813)
Miller, A. D., & Smith, K. M. (2006). Medication and nutrient administration consideration after bariatric surgery [PDF]. American Journal of Health-System Pharmacy, 63, 1852-1857. Retrieved from file:///C:/Users/Ross/Desktop/Cleary%20U/Medication%20Absorbtion%20PDF.pdf
Piper, L. (2013, August 15). Bipolar disorder patients eligible for bariatric surgery. Retrieved from http://www.medwirenews.com/47/104753/Psychiatry/Bipolar_disorder_patients_eligible_for_bariatric_surgery.html
Post, MD, R. M. (2013). Obesity and bipolar disorder risks [PDF]. Bipolar Network News, 17(4), 13. Retrieved from http://bipolarnews.org/wp-content/uploads/2010/05/BNN2013.4.pdf
