Medications · Mental health
Psychiatric Medications Before Surgery
Mental-health medicines are usually kept going through surgery — stopping them suddenly is often the bigger risk. Here's the type-by-type guide, including the two that need special timing.
Quick answer
Why it matters
For most mental-health medicines, stopping abruptly is more dangerous than continuing. Antipsychotics prevent relapse; benzodiazepines can cause a dangerous withdrawal (including seizures) if stopped suddenly; and anti-seizure mood stabilizers can trigger seizures if missed. These are generally taken right through, including the morning of surgery with a sip of water.
Lithium is the classic 'timing' drug. Because surgery shifts your fluids, salt and kidney function, lithium levels can swing into a toxic range, and lithium can also lengthen the effect of some anesthetic muscle relaxants. For that reason it's commonly held about 72 hours before a major operation, while it's often continued for minor procedures. Your team decides based on the surgery, and checks a level if needed.
ADHD stimulants (methylphenidate, amphetamine/Adderall, lisdexamfetamine/Vyvanse) are usually held on the day of surgery because they can raise heart rate and blood pressure and interact with anesthesia drugs. If you forgot and already took your dose, this rarely cancels the operation — just tell the team your last dose.
Whatever you take, the single most useful thing is an accurate list. Many of these drugs change how much anesthetic or pain medicine you need, so your anesthesiologist wants to know about them — there's no judgement, only safer dosing.
Do not stop without instruction
What to ask your doctor
- I take [name and dose] — do I take it on the morning of surgery?
- I'm on lithium — do you want it held, and do I need a level checked?
- Should I skip my ADHD stimulant the day of surgery?
- I take a benzodiazepine regularly — how will that affect my anesthesia and recovery?
Red flags — call your team
Red flags — call your team
- Signs of lithium toxicity before surgery — coarse tremor, vomiting/diarrhea, confusion, slurred speech: contact your prescriber.
- Severe anxiety, agitation, or any thoughts of self-harm around surgery — get urgent help; don't just stop your medicine.
- Fever, rigidity, confusion or a racing heart after surgery on antipsychotics — tell staff immediately.
References
- Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus on psychiatric medications, Mayo Clinic Proceedings 2021. mayoclinicproceedings.org
- Perioperative considerations for psychostimulants (ADHD medications), PMC 2023. ncbi.nlm.nih.gov
Frequently asked questions
Do I stop my anxiety or sleeping pills (benzodiazepines) before surgery?
Usually no — and you shouldn't stop them suddenly, because benzodiazepine withdrawal can be dangerous. Tell your team you take one (alprazolam, lorazepam, clonazepam, diazepam); it can change how much sedation you need. They'll guide the morning-of dose.
Should I hold lithium before surgery?
Often for major surgery, lithium is held about 72 hours before because fluid and kidney changes around surgery can push levels into a toxic range. For minor procedures it's frequently continued. Your team decides and may check a blood level — don't change it on your own.
Can I take my Adderall before surgery?
Usually it's held the morning of surgery, because stimulants raise heart rate and blood pressure and interact with anesthesia. If you already took it, that rarely cancels the case — just tell your anesthesiologist your last dose.
Do I keep taking my antipsychotic or seizure medicine?
Yes, almost always. Antipsychotics and anti-seizure mood stabilizers (valproate, lamotrigine, carbamazepine) are continued, including the morning of surgery, to prevent relapse or seizures. Confirm the exact plan with your pre-op team.