Background

Bariatric surgery is associated with weight loss and improvement of comorbidities and health-related quality of life, but the long-term effects on depression and anxiety are uncertain. We aimed to assess depression and anxiety ten years after start of surgical treatment (ST) or specialized medical treatment (MT) in patients with severe obesity.

Methods

Patients attending a tertiary care center were prospectively included in the Norwegian registry for patients with severe obesity (NORSO) between January 2006 and October 2009.At 10-year follow up Hospital Anxiety and Depression Scale (HAD) and use of antidepressants and anxiolytics was recorded. Patients treated first with MT and later received ST were included in the ST-group. A subgroup analysis of patient with no history of anxiety or depression at baseline was performed to investigate new onset of depression. Statistical analyses were performed with independent samples T-test and Fisher´s exact test as appropriate.

Results

A total of 586 patients (50%) attended the 10-year follow-up. (ST, n=427 and MT, n=159). Reported depression, anxiety and use of medication did not differ significantly between groups at baseline. Both groups experienced a sustained weight loss from start of treatment until ten years. The mean (SD) percentage total weight loss was significantly higher after ST; 24 (11)%, as compared with MT; 4 (14)%. At 10-year ST-patients reported significantly lower mean HAD-D score; 3.3 (3.3) than MT-patients; 4.5 (3.6). HAD-A scores and use of antidepressants (ST 14% vs. MT 10%, p=0.16) were comparable between groups. There was no difference between groups in new onset depression (ST: 17% vs. MT 21%, p=0.35) or use of antidepressants (ST: 6% vs. MT: 2%, p=0.18).

Conclusions

Ten years after start of treatment surgically treated patients reported less symptoms of depression than medically treated patients, but the use of antidepressants and the incidence of new-onset depression did not differ significantly between groups.