Section - Quick Takes

01. SSRI/SNRI Concentrations After Bariatric Surgery and Effects on Depressive Symptoms

Published on January 1, 2024 Certification expiration date: January 1, 2027

Scott R. Beach, M.D.

Associate Professor of Psychiatry - Harvard Medical School - Massachusetts General Hospital

Key Points

A significant number of bariatric surgery patients are on antidepressants, which often continue postsurgery.
Bariatric surgery, like gastric bypass, can alter the absorption and levels of psychiatric medication due to changes in stomach and intestinal function.
It's important to closely monitor psychiatric symptoms after surgery and adjust medication dosages if necessary due to variable changes in drug levels.

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Bariatric surgery is an increasingly popular treatment for obesity; annually, at least 200,000 surgeries are conducted in the United States. Chances are some of your patients have had or are considering gastric bypass or weight loss surgery.

I’m Scott Beach, and this is Quick Takes.

Most insurers require patients undergoing bariatric surgery to have a psychosocial assessment, including a psychiatric evaluation, as part of the prescreening process. Active binge-eating disorder, bulimia, and active substance use disorders are some contraindications for bariatric surgery. Comorbidities are very common in this patient population, with depression affecting at least one-fifth of patients who present for surgery and representing the most common psychiatric comorbidity in at least 1 study. A history of trauma is also exceedingly common, with one-fifth to one-quarter of patients reporting trauma in the form of childhood physical or sexual abuse specifically. Depression and PTSD are not necessarily contraindications to surgery, but

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02. Psychedelics as Transformative Therapeutics

Learning Objectives:

Recognize the importance of closely monitoring psychiatric symptoms and managing medication effectively after bariatric surgery.
Differentiate psychedelic compounds based on their specific mechanisms of action and effects, particularly their interaction with the 5HT2A receptor.
Discuss the efficacy and safety of antidepressants in patients with medical illnesses and understand how to manage their potential lesser tolerability compared with placebo.
Discuss the role of orexin in sleep regulation and how its antagonism by medication like daridorexant can effectively treat insomnia.
Explore the potential benefits of early clozapine initiation in the course of treatment-resistant schizophrenia.

Original Release Date: January 1, 2024

Review and Re-release Date: March 1, 2024

Expiration Date: January 1, 2027

Experts: Scott Beach, M.D., Carlos Schenck, M.D., Oliver Freudenreich, M.D., Sydney LeFay, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

Oliver Freudenreich declares the following interests:

- Alkermes: Research grant, consultant honoraria

- Janssen: Research grant, consultant honoraria

- Otsuka: Research grant

- Karuna: Research grant, consultant honoraria

- Neurocrine: Consultant honoraria

- Vida: Consultant honoraria

- American Psychiatric Association: Consultant honoraria

- Medscape: Honoraria

- Wolters-Kluwer: Royalties

- UpToDate: Royalties, honoraria

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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Participants must complete the activity online during the valid credit period that is noted above.

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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.