After a gastric bypass, the way your body handles medication often changes, but it does not necessarily become more efficient or “better.” In fact, the surgery alters how drugs are absorbed because food and medications no longer pass through the full length of the stomach and small intestine. This reduced contact can make absorption less predictable, especially for extended-release or coated tablets. For that reason, many patients do better with immediate-release, liquid, chewable, or dissolvable forms of medication. For psychiatric medications, including antidepressants and sleep aids, this variability is important. Some patients experience lower blood levels after surgery and require dose adjustments, while others absorb medications more quickly. Because you already struggle with treatment-resistant depression and anxiety, close monitoring with your psychiatrist is essential. They may consider checking drug blood levels where possible, adjusting doses, or even switching to a different formulation or route of administration. Your Crohn’s disease adds an additional factor, as the intestine is already less reliable at absorbing medications and nutrients. Injectable or infusion therapies, such as biologics, are not affected by bypass, but oral medications for mood, sleep, or pain can become more inconsistent. Vitamin and mineral deficiencies are also very common after bypass, particularly B12, folate, iron, and vitamin D, and each of these can worsen fatigue, mood, and sleep if not addressed with supplementation. Regarding sleep, weight loss itself may help if conditions like sleep apnea are contributing, but medications such as zolpidem may not suddenly become more effective simply because of the surgery. What usually helps most is a careful review of your entire regimen, combined with attention to non-medication treatments such as structured sleep hygiene or cognitive-behavioral therapy for insomnia. In summary, gastric bypass does not guarantee that your medications will work more evenly or predictably. In many cases, absorption is less consistent, which is why working closely with both your bariatric team and your psychiatrist is so important. With careful monitoring, adjustments, and correction of nutritional deficiencies, patients often find that their overall mental and physical health improves with weight loss, even if the medication management requires more fine-tuning.