Medications · Mental health
Antidepressants Before Surgery
If you take an antidepressant, the usual advice may surprise you: keep taking it. Here's what the guidelines say for each type — and the one kind that needs a heads-up to your anesthesia team.
Quick answer
Why it matters
Surgery and recovery are stressful, and an abrupt stop to an antidepressant can cause a relapse or a discontinuation syndrome (dizziness, flu-like feelings, mood changes) — especially with short-acting drugs like venlafaxine or paroxetine. For almost everyone, the benefit of staying on the medicine outweighs the small risks of taking it around surgery.
SSRIs and SNRIs slightly reduce how well platelets help blood clot, so there is a small increase in bleeding. This matters mainly for operations with a very high bleeding risk (some brain or large reconstructive surgery), where your surgeon — not you — may weigh it. For routine surgery it is not a reason to stop.
The bigger safety point is drug combinations, not the antidepressant itself. To avoid serotonin syndrome, anesthesia teams simply avoid certain add-on drugs in people on serotonergic antidepressants — for example the pain medicines meperidine (Demerol) and tramadol, and a few others. That's their job; your part is to make sure they know what you take.
MAOIs are the special case. The modern approach is usually to continue the MAOI and use an 'MAOI-safe' anesthetic (avoiding meperidine, tramadol, and indirect blood-pressure drugs like ephedrine), because forcing a two-week stop can be dangerous for your mental health. This only works if your anesthesiologist knows in advance.
Do not stop without instruction
What to ask your doctor
- I take [name and dose] — should I take it as usual on the morning of surgery?
- I'm on an MAOI — what does my anesthesia plan need to avoid? (Tell them early.)
- Is my surgery high-bleeding-risk enough that my SSRI/SNRI matters?
- Which pain medicines should be avoided because of my antidepressant?
Red flags — call your team
Red flags — call your team
- Confusion, high fever, fast heart rate, sweating, shivering or muscle twitching after surgery — possible serotonin syndrome; tell staff immediately.
- Severe return of depression, or any thoughts of self-harm, around your surgery — contact your prescriber urgently.
References
- Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus on psychiatric medications, Mayo Clinic Proceedings 2021. mayoclinicproceedings.org
- Reviews of serotonin syndrome and SSRI bleeding risk in the perioperative period (PMC). ncbi.nlm.nih.gov
- MAOI–anesthesia interactions, OpenAnesthesia. openanesthesia.org
Frequently asked questions
Do I stop my SSRI before surgery?
Usually no. SSRIs like sertraline, fluoxetine and escitalopram are normally continued, taken as usual on the morning of surgery with a sip of water. Stopping risks relapse and withdrawal. There's only a small bleeding consideration for very high-bleed surgery, which your surgeon weighs.
Is it safe to have anesthesia on antidepressants?
Yes — anesthesia is given safely to people on antidepressants every day. The team simply avoids a few specific add-on drugs (like the pain medicines meperidine and tramadol) to prevent serotonin syndrome. Make sure they know exactly what you take.
What about MAOIs and anesthesia?
MAOIs (phenelzine, tranylcypromine, selegiline) need special planning. The modern approach is usually to continue the MAOI and use an 'MAOI-safe' anesthetic that avoids certain drugs. Tell your anesthesiologist as early as possible, and don't stop it on your own.
Will stopping my antidepressant for a few days hurt?
It can. Short-acting antidepressants such as venlafaxine and paroxetine cause noticeable discontinuation symptoms quickly, and any abrupt stop risks relapse. That's why continuing is usually preferred — let your prescriber and pre-op team decide, not a web page.