Does Bariatric Surgery Turn You into a Sex Maniac?

I was surprised when I walked into the exam room to see my next patient. Her chart identified her as a new patient, although her name was vaguely familiar. I realized why when I saw Susan (not her real name) waiting for me on the exam table. She was a pharmaceutical salesperson (we call them “Drug Reps”) who had only recently started calling on me. About two weeks ago her company had hired me as a speaker to promote one of their (non weight loss) drugs that I prescribe in my general practice. The meeting was held in a private dining room of a trendy restaurant. Very few physicians showed up and there was a lot of time to kill with me chatting with the reps from this company. Naturally a lot of the conversation centered around weight loss, since that is my specialty .

Susan met me for the first time at that meeting. She was about thirty years-old, very articulate and intelligent. She had an attractive face and she appeared to be just a smidge over ideal weight. I remember thinking that her interest in weight loss seemed out of proportion to her own situation, but that is not common, especially with women.

She was very tense and tearful, totally at odds with the very professional and relaxed appearing woman that I had chatted with recently. “Can you take Wellbutrin and Phentermine together?” she blurted out, choking back tears. “Does Wellbutrin cause you to act crazy?”

I should explain here that Wellbutrin is anti-depressant, the only anti-depressant that doesn’t cause weight gain (and may cause a small weight loss). Phentremine is an appetite suppressant that I commonly prescribe.

This was an unusual way to start a physician/patient relationship, to say the least. I asked her to back up and explain why she wanted to know, and also why she was so upset.

Her story was hair-raising. It seems that immediately after my meeting with her, her husband and her own parents had had her committed for a few days to a psychiatric hospital. She had just gotten out before our visit.

After the birth of her daughter, now aged eight, her husband had stopped having sexual relations with her. She ate out of depression and her rate ballooned to almost 300 pounds. Unable to lose the weight, she had bariatric surgery and went down to 150.

Then it got interesting. She began to participate in Internet groups looking for sexual partners. After a few months she let herself be filmed having sex with three men simultaneously. As what happens every time something like this occurs someone who knew her and her family saw these pictures and alerted her family.

She had been placed on Wellbutrin a few months prior to the surgery for depression and her family was trying to blame this drug for her behavior. She had regained 15 pounds during her week in the Psych hospital, wanted to take Phentermine and continue her Wellbutrin (thus her opening question to me).

Her story interested me even more than it normally would because of a few other patients that I have seen recently. Another one had had bariatric surgery in Ohio, had moved to Chicago and wanted me to follow her. She had asked for an HIV test and in the course of counseling her, she let slip that since she had lost weight in surgery she was participating in orgies (her husband also participated--at least this time it was a family activity).

Another patient was seeing me because her husband had had bariatric surgery and was losing weight rapidly and she wanted to lose some weight non surgically. On her third visit she was crying because two nights before she had caught him on the Internet entering his info into E-harmony. She proceeded to divorce him.

The psychiatric literature is replete with articles about patients who after bariatric surgery become addicted to alcohol, cocaine and other drugs, or compulsive gamblers. The speculation by the various authors is that some obese people tend to engage in compulsive behaviors (such as overeating). When they can no longer overeat because of the surgery, they find other outlets for their compulsions.

I have to say that after many years of helping people lose weight non-surgically I haven’t seen that kind of problem in my patients. Perhaps because these people have to work at it, and as part of that they wind up examining what makes themselves tick, and they learn how to deal with their compulsions rationally. The patients who go for surgery tend not to be to introspective: they want the quick fix and they don’t really want to examine their lives and make changes. I’m not going to pretend that I have all the answers. However, I do think examining the question is very interesting...