Psychiatric Complications Following Bariatric Surgery: Pathophysiological Mechanisms, Psychopathological Factors and Therapeutic Approaches

Abstract

Introduction: Bariatric surgery is a widely utilized intervention for the treatment of severe obesity; however, its effects extend beyond weight loss and may involve significant neurobiological and psychopathological alterations, potentially inducing or exacerbating psychiatric disorders. This article aims to analyze these phenomena by articulating physiology, neuropsychiatry, and psychopathology, grounded in contemporary research. Methodology: A literature review was conducted, encompassing studies in Portuguese and English, prioritizing research published within the last seven years without excluding seminal references pertinent to the conceptual framework. Results and Discussion: The findings indicate that bariatric surgery promotes significant modifications in gut-brain axis signaling, lipid and steroidal metabolism, and the absorption of micronutrients essential for neurotransmission. Furthermore, it alters the secretion of gastrointestinal neuropeptides and the regulation of the hypothalamic-pituitary-adrenal and gonadal axes. These changes may impact central serotonergic, dopaminergic, and GABAergic systems, fostering the onset or worsening of symptoms such as anxiety, depression, insomnia, affective lability, impulsivity, and increased vulnerability to addictive behaviors—particularly in individuals with pre-existing psychopathology or emotional self-regulation strategies based on hyperphagia. Conclusion: Bariatric surgery must be understood as a process of prolonged neurobiological transition, requiring continuous psychiatric monitoring, with individualized nutritional, psychotherapeutic, and pharmacological interventions to preserve psychiatric health and long-term quality of life.