Dear Dr. So-and-So, et. al.:
I read with tremendous interest and a degree of de ja’ vu the front-page story written by Ms. Michael Sneed in the Sunday, August 5, 2012 Chicago Sun-Times which reported that U.S. Representative Jesse Jackson Jr. recently collapsed and had become completely debilitated by depression. Upon reading the story, I experienced a staggering degree of recognition, for I too, have (and continue to do so) hit the same kind of wall as Representative Jesse Jackson Jr.: A crippling mental illness diagnosis, specifically major depression (changed later to Bipolar II) following gastric by-pass surgery.
The story reported that Ald. Sandi Jackson (wife of Representative Jesse Jackson Jr.) doesn’t know if her husband’s depression is connected to his weight-loss surgery. As a person who finds himself in a very similar situation the development of major depression after elective gastric by-pass surgery) I would like to suggest that determining the cause of this on-set of depression is irrelevant and nearly impossible to determine. Based on the past four years of failed orally administered pharmaceutical treatment attempts, I strongly suggest that you titrate the dosing levels of psychotropic therapies dramatically (50%-75% higher) or increase the potency of the psychotropic therapies to compensate for the substantial degree of malabsorption (the basic tenet of Duodenal Switch Surgery) caused by the significant reduction in stomach volume (up to 70%) and the dissection and rerouting of a large percentage of the small intestine (which is largely responsible for caloric absorption). If the goal of the Duodenal Switch surgery is to limit volume and reduce absorption of food ingested orally, then common sense suggests that anything ingested orally will greatly lose its effectiveness (especially if the drug’s efficacy during clinical trials was based on subjects that did not undergo weight-loss surgery). Except now we want the body to absorb what it’s ingesting!
I endured two needless years of trial and error attempting to discover pharmaceutical regimen which would lift me from depression and put a lid on my mania. My psychopharmacologist knew I’d undergone gastric by-pass surgery a decade earlier yet refused to consider malabsorption as the cause of the ineffectiveness of every single prescription. Frustrated by my psychiatric team’s myopia, I returned to the care of my internist; he was the first doctor to consider that my body’s ability to absorb oral treatments had been reduced by as much as 75%. If an increase in dosage is impossible, then a different delivery system (IV, inhalation, transdermal patch, suppository) must be manufactured. Please don’t waste Representative Jesse Jackson Jr.’s time prescribing the usual litany of drugs at their recommended doses: It’s akin to trying to stop a charging elephant with a water pistol.
Morbidly obese patients who were diagnosed as depressed and were being treated successfully through oral medications prior to gastric by-pass surgery discovered that post surgery their depression worsened and their pre-surgery oral medication treatment failed to reproduce the expected degree of pre-surgery success and relief. Your patient is in crisis; your patient is experiencing a major depressive episode; your patient’s natural ability to absorb what he ingests has been compromised to the degree of ineffectiveness; your patient needs an extraordinary, preposterous, wholly unimaginable antidote, not a boilerplate solution.
I salute the Jackson family for supporting Representative Jesse Jackson Jr. through this difficult period and wish them all God’s speed.