There is accumulating evidence that taking SSRI antidepressants increases the risk of bleeding and other complications during surgery, according to a review published in the British Journal of Anaesthesia.
The use of antidepressants have continued to grow in recent years, and they are now among the most commonly prescribed medications in the United States. This means that many patients are presenting for surgery with SSRIs in their system.
Researchers are now bringing increased attention to the risks that SSRIs could pose to those going into surgery. SSRIs inhibit the reuptake transport of serotonin in the brain and serotonin, among other things, is used in the process of platelet activation that allows blood to clot. For this reason, researchers have found that the frequency of bleeding complications appears to rise in proportion to the degree of serotonin reuptake inhibition by antidepressants.
According to the authors of a recent review of SSRIs and surgery risk, “drugs such as clomipramine, fluoxetine, sertraline, and paroxetine produce more potent blockade of the serotonin transporter and further increase bleeding potential.”
The authors document a series of studies which implicate SSRI drugs with increased medical risks, including: gastrointestinal blood loss, development of postpartum hemorrhage, spontaneous epidural haematoma, airway bleeding, and increased bleeding during early pregnancy, hip fracture surgery, and after stroke.
“Clinicians should be aware that SSRI’s may contribute to perioperative bleeding and mortality and in individual patients at high risk of this complication may choose to actively discontinue the SSRI,” they write.
Shepherd, S. J., Fiandeiro, C., & Sanders, R. D. (2015). Selective serotonin reuptake inhibitors: depressing perioperative outcomes?. British journal of anaesthesia, aev065. (Overview)