**2.9 Mental health**

Due to the significant association of depression with obesity, it is a common disorder among individuals selected for BS. LSG results in significant improvement in various psychological dimensions. At one year post LSG, depressive symptoms, self-esteem, eating behavior and cognitive restraint showed improving trends [34]. Eating behavior also improves post LSG. In a prospective study of 75 individuals before and 48 months after LSG, the number of patients with binge eating disorder was lower at follow up (decreased from 13% to 2%) [35]. Similarly, the subscales of disinhibition and feelings of hunger both decreased post LSG (p < 0.001 for both) [35]. An important outcome post BS is the effect on psychiatric medications, specially depression and anxiety medication. A retrospective study of 50 patients found that at 3- to 6-months post LSG, anxiety symptoms improved in >50% of subjects and most patients were on the same or reduced dosage of medication (62% unchanged, 24% decreased) [36]. Depression symptoms improved in 67%, while 62% of them remained in the same regimen and 26% discontinued their medications [36]. This suggests that LSG not only results in early improvement in symptoms of depression or anxiety, but also reduces the dosage of psychiatric medications [36].
