Bipolar and weight-loss surgery

Tucked into today’s Mayo Clinic announcement that Rep. Jesse Jackson is being treated for bipolar disorder is the role weight-loss surgery has had.

Here’s the full news release:

Following extensive evaluation, Congressman Jesse Jackson, Jr. is undergoing treatment for Bipolar II depression at Mayo Clinic in Rochester, Minn. Congressman Jackson is responding well to the treatment and regaining his strength.

Many Americans have bipolar disorder. Bipolar II disorder is a treatable condition that affects parts of the brain controlling emotion, thought and drive and is most likely caused by a complex set of genetic and environmental factors. Congressman Jackson underwent gastric bypass surgery in 2004. This type of surgery is increasingly common in the US and can change how the body absorbs food, liquids, vitamins, nutrients and medications.

Congressman Jackson has asked Mayo Clinic to distribute this information on his behalf. He and his family remain grateful for support and prayers offered and received on his behalf.

The middle paragraph is the eye opener — a suggestion that the congressman’s bipolar disorder is because of weight-loss surgery, although it may be an unfortunate piece of writing in which “caused by” was used in the previous sentence.

It would be unusual to hear a suggestion that weight-loss surgery could cause bipolar disorder. More than likely, what’s being pointed out is the bipolar episode is connected to weight-loss surgery.

According to the Harvard Mental Health Letter, people eligible for weight loss surgery often have a history of mental health problems or eating disorders.

According to its 2008 article:

The Harvard Mental Health Letter notes that mood disorders such as depression and anxiety affect many people who are eligible for bariatric surgery. The weight loss following surgery generally improves mood, at least initially. In studies, depression and anxiety scores were reduced significantly one year after surgery, but tended to be higher two and four years later. And some research has found higher-than-expected rates of suicide among surgery patients.

Eating disorders, such as binge eating, also affect many people considering bariatric surgery. And a highly controversial theory–as yet unproven–is that bariatric surgery may cause some people to lose weight but then “transfer” their food addiction to some other harmful addiction. Surgery may change the rate at which alcohol is absorbed, which may increase the risk of dependence in people who are vulnerable to becoming addicted. All of these factors underscore the need for mental health treatment before and after surgery, says the Harvard Mental Health Letter.

When we read about weight-loss surgery, we often are witness only to the before and after. It’s clear from many stories, that there’s a painful physical and emotional “right after” that rarely gets documented. In patients who are already taking medication for bipolar disorder, the physiological changes afterwards makes the medication problematic, according to Canadian studies cited by the National Institutes of Health:

The impact of bariatric surgery on psychiatric pharmacotherapy has not received much attention, and few specific recommendations exist to optimize medication regimens for this population. Based on potential for decreased absorption, it has been suggested that patients taking lamotrigine, olanzapine and quetiapine be monitored for decreased efficacy, as should those on controlled or extended-release antidepressants. Given that lithium is influenced by factors such as fluid volume, levels of this medication should also be monitored postoperatively to prevent problems with toxicity.

Patients with a psychiatric illness are especially vulnerable to obesity, and as a consequence of the factors contributing to weight gain in this population, they may also be less amenable to changes in diet and exercise alone. Bariatric surgery, a weight-loss tool that essentially cures obesity-related comorbidities such as type II diabetes, hypertension and dyslipidemia, may be lifesaving for this population and is an option that we need to thoroughly consider.

Jackson’s weight-loss surgery was eight years ago. But bipolar is a lifelong illness that can only be managed.

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