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首页> 外文期刊>International clinical psychopharmacology >Treating mood disorders in patients with a history of intestinal surgery: a systematic review
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Treating mood disorders in patients with a history of intestinal surgery: a systematic review

机译：有肠道手术史的患者的情绪障碍治疗：系统评价

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Bariatric surgery is increasingly being performed, with the intended benefits of significant and durable weight loss. Radical surgical resection can result in short bowel syndrome (SBS), a rare and devastating condition. Psychological distress is common in these patients. Relevant articles were identified by searching Pubmed and EMBASE databases with the following keywords: 'Bariatrics'[Mesh] OR 'Short Bowel Syndrome' AND 'Antidepressive Agents' OR 'Psychotropic Drugs'[Mesh]. One in-vitro study, four clinical studies and six relevant case reports were identified. Most clinical studies on antidepressant focused on the Roux-en-Y gastric bypass (RYGB); these results are somewhat conflicting for a variety of reasons including different methodologies and small sample sizes. One month after RYGB, in patients receiving serotonin or serotoninoradrenaline reuptake inhibitors, antidepressant levels decrease to 50% of preoperative levels and return to baseline (or greater) by 6 months in almost all patients. Other pharmacokinetic studies have shown that, 1 year after RYGB, duloxetine and sertraline levels are significantly reduced in comparison with the control population. Paradoxically, in patients with SBS and a few years after surgery, high concentration to dose ratios have been reported for citalopram and escitalopram; this may be because of an intestinal adaptation. Surgery of the intestine is likely to modify absorption and first-pass metabolism of drugs; managing the treatment of depression and anxiety in bariatric and SBS patients therefore presents a major challenge. Close clinical follow-up, associated with therapeutic drug monitoring when available, should enable the optimization of treatment response and modulate the risk of adverse events. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
机译：减肥手术正在越来越多地进行，其预期的好处是显着且持久的减肥效果。根治性手术切除可导致短肠综合征（SBS），这是一种罕见的破坏性疾病。这些患者常见心理困扰。通过在Pubmed和EMBASE数据库中搜索以下关键词来识别相关文章：“ Bariatrics” [Mesh]或“ Short Bowel Syndrome”和“抗抑郁药”或“ Psychotropic Drugs” [Mesh]。确定了一项体外研究，四项临床研究和六例相关病例报告。关于抗抑郁药的大多数临床研究都集中在Roux-en-Y胃搭桥术（RYGB）上。由于各种原因，包括不同的方法和较小的样本量，这些结果有些矛盾。 RYGB治疗一个月后，接受5-羟色胺或5-羟色胺/去甲肾上腺素再摄取抑制剂的患者中，几乎所有患者的抗抑郁药水平均降至术前水平的50％，并在6个月后恢复至基线（或更高）。其他药代动力学研究表明，RYGB 1年后，与对照组相比，度洛西汀和舍曲林水平显着降低。矛盾的是，在SBS患者和手术后的几年中，据报道西酞普兰和依他普仑的浓度与剂量之比很高。这可能是由于肠道适应。肠外科手术可能会改变药物的吸收和首过代谢。因此，在肥胖症和SBS患者中管理抑郁症和焦虑症的治疗面临着重大挑战。密切的临床随访以及与治疗药物的监测（如可用）相关联，应能够优化治疗反应并调节不良事件的风险。版权所有（C）2015 Wolters Kluwer Health，Inc.保留所有权利。

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