Table 2: Prevalence of affective disorders after surgery.

Author and Publication year	Country	Study features	N Participants	Mean age	Sex	Other features of the study	Surgery/setting	Instruments	Results
Ivezaj V & Grilo Cm 2015 [45]	New Haven (CT-USA)	Prospective, longitudinal study	107		94 F; 13M	To evaluate the frequency of bariatric patients who experienced discernible increases in depression levels following surgery and explored their correlates. 6- 12- months follow up	RYGB	BDI; Eating Disorder Examination EDE-Q; Self-esteem (RSES), Social functioning (SF-36)	14 (13.1 %) participants reported discernible increases (BDI-Increase), 14 (13.1 %) reported discernible decreases (BDI-Decrease), and 79 (73.8 %) did not report discernible changes (no change) in BDI scores from 6 to 12 months postsurgery. By 12 months postsurgery, the BDI-Increase group had significantly higher depression scores.
Nepal H et al. 2015 [47]	Springfield (IL-USA)	Case report	1	57	F	One of complications after bariatric surgery is represented by neuropsychiatric disorders and psycho-behavioral symptoms. Onset 2 monts after surgery.	RYGB	Psychiatric evaluation, clinical interview	Primary mania.
Ahmed AT et al. 2013 [60]	San Francisco (USA)	Prospective, longitudinal study	144 patients with bipolar disorder who underwent BS and 1440 controls	43.9+/-10	88.9% F, 11. 1%M	To determine if bariatric surgery alters psychiatric course among stable patients with bipolar disorder	Bariatric surgery	Psychiatric hospitalization: defined as any inpatient stay at a psychiatric hospital.	9% BS and 10.6% unexposed to surgery had psychiatric hospitalization during follow-up.
Cunningham JL et al. 2012 [46]		Retrospective study	439			Antidepressant usage after sugery	RYGB		23% increase antidepressant, 40% same antidepressant, 18% change, 16% decrease or discontinued antidepressant.
de Zwaan et al. 2011 [38]	Nuremberg, Germany	Prospective, longitudinal study	107	37.5 +/- 9.7	32 M; 75 F	Assessment after 6-12 months and 24-36 months.	Bariatric surgery	SCID -I	The point prevalence of depressive disorders but not of anxiety disorders decreased significantly after surgery. Patients with both depressive and anxiety disorders at baseline (current and lifetime) lost significantly less weight after surgery. Postoperative depressive disorder was negatively associated with weight loss at the 24–36 month follow-up assessment point.
Hayden et al. 2011 [40]	Victoria, Australia	Prospective, longitudinal study	191	41+/-9		Assessment at baseline and after 12 months	LAGB	BDI	Patient scores on the negative self-attitude subscale were significantly greater than the two other subscales and showed the greatest improvement 1 year following LAGB.
Sultan et al. 2009 [41]	New York	Prospective, longitudinal study	53	46.9		BMI lower than 35, follow up 2 years. Study parameters included preoperative age, gender, BMI, presence of comorbidities, percentage of excess weight loss (%EWL), and resolution of comorbidities.	LAGB		Substantial improvement occurred for the following comorbidities evaluated: hypertension, depression, diabetes, asthma, hypertriglyceridemia, obstructive sleep apnea, hypercholesterolemia, and osteoarthritis.
Segal JB et al. 2009 [29]	Baltimore (USA)	Retrospective study	6235	44	M/ F (F = 82%)	To compare the mean number of medications at the time of surgery and in the subsequent year	RYGB, Gastroduodenostomy		Decrease in the mean number of prescriptions filled for antidepressant medications, with a 9% decrease by 12-months.
Schowalter et al. 2008 [42]	Wuerzburg, Germany	Prospective, longitudinal study	248			128 patients were treated with gastric banding and 120 controls	LAGB	BDI	In the preoperative assessment, 35% of all obese patients suffered from clinically relevant depressive symptoms. After 5 to 7 years, patients with gastric banding improved significantly in depression, whereas no change was found in patients without gastric banding.
Burgmer et al., 2007[39]	Dortmund, Germany	Prospective, longitudinal study	149	38.8 ± 10.3	47 M; 102 F	To evaluate depressive symptoms, self-esteem and health-related quality of life 2 years after bariatric surgery.	Gastric restrictive surgery		Pre-surgery, 40.5% (n=62) of the patients suffered from depressive symptoms of clinical relevance. These depressive symptoms persisted in 17.7% (n = 27) 1 year and in 16.4% (n = 25) 2 years after surgery.
Emery et al. 2007 [43]	Columbus (USA)	Prospective, longitudinal study	13	46.9 ± 5.7	F	To examine the relationship of inflammation and depression among gastric bypass patients in a 12-month longitudinal study.	RYGB	Self-report measures of depression	Significant reductions in BMI, participants experienced significant reductions in C-reactive protein (CRP), IL-6, and depressive symptoms. Decreased depression during the 12-month follow-up was highly correlated with reduced CRP.
Dixon et al. 2003 [3]	Melbourne, Australia	Prospective, longitudinal study	487	41.2 ± 9.7	M (15%)/ F	To examine depression before and after surgically induced weight loss.	LAGB	BDI	Weight loss was associated with a significant and sustained fall in BDI scores, with a mean +/- SD score of 7.8 +/- 6.5 at 1 year and 9.6 +/- 7.7 at 4 years after surgery. Greater falls in BDI score at 1 year were seen in women, younger subjects, and those with greater excess weight loss.
Kaltsounis et al. 2000 [26]		Case report	1	27	M	To report the use of intra- venous valproate sodium for the treatment of severe manic symptoms that developed after gastric bypass surgery	RYGB	Monitoring during hospedalization; C linician-Administered Rating Scale for Mania (CARS-M)	Intravenous valproate was initiated conservatively at approximately 4 mg/ kg every 60 minutes. Intravenous administration of valproate seemed to be efficacious, well tolerated, and pharmacokinetically appropriate.

F: Female; M: Male; BS: Bariatric Surgery; BMI: Body mass Index; RYGB: Roux-Y-Gastric Bypass; LAGB: Laparoscopic Adjustable Gastric Banding; MDD: Major Depressive Disorder; BD: Bipolar Disorder; SCID-I: Structured Clinical Interview for DSM IV Axis I disorders; BDI: Beck Depression Inventory; Beck Depression Inventory-II (BDI-II)