The risk of stopping antidepressants before plastic surgery may outweigh any benefits associated with discontinuation, according to new research on the issue.
The study, which appears in the November issue of Plastic and Reconstructive Surgery®, looked at whether antidepressant use before and during plastic surgery increase risk of bleeding, breast cancer, and other adverse outcomes among patients. Stopping antidepressants before plastic and reconstructive surgery is unlikely to reduce complications—and might actually increase the risk of postoperative problems related to the patient’s underlying depression, the study authors concluded.
Antidepressant use has increased in recent years, with one study reporting that 1 out of 10 US adults and adolescents use these medications. Rates of antidepressant use may be even higher among patients undergoing cosmetic plastic surgery, or patients with breast cancer undergoing breast reconstruction. Isabel Teo, MD, of Ninewells Hospital, Dundee, and medical student Christopher Tam Song of University of Edinburgh performed an in-depth review of research data on the risks of antidepressant treatment in plastic surgery. They analyzed 26 studies assessing the effects of antidepressants on various plastic surgery risks, including:
Bleeding
Six studies assessed the impact of antidepressants and bleeding risk in more than 34,000 patients undergoing breast cancer surgery and 2,500 undergoing cosmetic plastic surgery. The results were inconsistent: while some studies found increased bleeding rates in patients taking antidepressants, others found no such risk.
The evidence doesn’t fully rule out an increase in bleeding risk. Stopping antidepressants before surgery might worsen depression symptoms or lead to a potentially disastrous “discontinuation syndrome,” the authors conclude. “Therefore, routine discontinuation of antidepressants before surgery in the absence of a careful evaluation should be avoided.”
Breast cancer risk
Six reports—mainly large meta-analyses of previous data—examined the risk of breast cancer among patients taking antidepressants. Again, the results were conflicting: some reviews found a “modest” increase of breast and ovarian cancer among antidepressant users, while others found no relationship.
Breast cancer outcomes
Six studies including more than 11,000 patients examined whether antidepressants might interfere with tamoxifen. Most studies found no evidence that this drug combination increased the risk of recurrent breast cancer. However, there was a possible interaction between tamoxifen and one specific antidepressant—the SSRI paroxetine.
Breast enlargement
One study of 59 patients suggested a possible increase in the risk of breast enlargement and pain among women taking SSRIs. However, most patients with breast enlargement also had weight gain—a known side effect of SSRI use.
A handful of studies looked at various other complications. One reported an increased risk of seromas after plastic surgery in patients taking SSRIs. Another reported a possible interaction between SSRIs and methylene blue dye used for lymph node mapping in patients with breast cancer.
The risks of stopping prescribed antidepressant therapy in “psychologically vulnerable” patients likely outweigh any increase in complications, the study authors conclude. “The use of antidepressants for mental disorders may also implicate key patient risk factors for surgical complications and sufficient exploration into the patient’s indications for the prescription is crucial.”
