Antidepressants are usually continued through surgery, because stopping them can cause withdrawal, return of depression, or more anxiety. SSRIs, MAOIs, TCAs, SNRIs, anxiolytics, antipsychotics, and mood stabilizers are typically continued in the perioperative period.

The main anesthesia concerns are drug interactions and bleeding risk. SSRIs can slightly raise bleeding risk by affecting platelets, and the risk is higher when they are combined with other blood thinners. Some teams may taper SSRIs 2 to 3 weeks before surgery for high-bleeding-risk cases, such as intracranial, spinal, major cardiac, or when combined with dual antiplatelet therapy.

Some pain and anesthesia drugs can also raise the risk of serotonin syndrome, which is caused by too much serotonin. Signs can include agitation, sweating, fast heart rate, high blood pressure, fever, clonus, rigidity, and confusion. Drugs named in the sources include meperidine, tramadol, fentanyl, methadone, and methylene blue. SSRIs such as citalopram and escitalopram can also affect the QT interval, which is a measure of heart rhythm.

Verify the exact plan with your surgical or anesthesia team in case they want something different for you.