SSRI use may increase risk of complications in surgery

A new SSRI antidepressant study cited in the Journal of the American Medical Association (JAMA, April 29, 2013) analyzed data from over 500,000 patients who underwent major surgery between 2006 and 2008 and found a correlation between SSRI usage (selective serotonin reuptake inhibitors) and: 1) an elevated risk of bleeding, 2) the need for blood transfusions following operations, 3) readmission to the hospital, 4) irregular heartbeats, and 5) possible death.

The lead investigator, Dr. Andrew Auerbach, (professor of Medicine, University of California, San Francisco) conducted the study, the largest of its kind to date. Looking at rates of adverse outcomes in patients taking SSRI antidepressants while controlling for depression, age, gender, and initial condition requiring surgery, the correlation between SSRIs and adverse events remained. Individuals taking SSRIs are more likely to have other conditions take can complicate surgery such as obesity, chronic pulmonary disease and hypothyroidism. Adjusting for these factors, researchers still found that patients taking SSRIs were more likely to experience bleeding, be readmitted at 30 days, and to die in the hospital.

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant drugs that include Zoloft, Paxil, and Prozac. These popular antidepressants are among the most commonly prescribed medications in the United States. Used to treat anxiety depression and even pain, they prevent nerve cells in the brain from reabsorbing serotonin. Unfortunately, in so doing there may be interference with the function of platelets critical for helping blood to clot properly.

Previous studies of SSRI antidepressants including Zoloft have looked into the increased birth defects risks when used during pregnancy and possible association with suicide among adolescents. There have also been a handful of studies linking SSRIs to increased risk of hemorrhaging in both surgical patients and ambulatory patients.

Due to the increased risk, some hospitals now recommend that patients using SSRIs stop taking them for about two weeks before a scheduled surgery. However, in the accompanying editorial, Dr. Mark Mrkobrada and Dr. Daniel G. Hackman wrote: ” Overall…we do not believe the evidence base has evolved sufficiently to confirm that patients should routinely have their SSRI therapy tapered or discontinued before surgery.” More SSRI antidepressant studies will need to be done.

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