Antidepressants and Plastic Surgery: How Complicated?
What is the relationship between antidepressants and plastic surgery? What do doctors and patients need to know?
With more and more Americans taking medication to ease depression and anxiety—as many as 1 in 10, according to an article in the most recent issue of Plastic and Reconstructive Surgery—it’s important to understand what current research suggests.
The New Findings
The article, titled Assessing the Risks Associated with Antidepressant Use in Plastic Surgery: A Systematic Review, summarizes the findings of two U.K. researchers. They independently reviewed medical literature and extracted relevant information to assess whether antidepressants cause increased risk of excess bleeding, breast cancer, breast cancer recurrence, breast enlargement and other complications following plastic surgery. The scientists discovered that patients who take antidepressants suffer little to no additional risk of post-surgical complications.
Of course the findings are more complex than the general conclusion—chiefly due to the differences in the way the wide array of antidepressants work. For instance, selective serotonin reuptake inhibitors, or SSRIs, may reduce the benefits of tamoxifen in preventing breast cancer recurrence post-surgery. The researchers mention paroxetine (Paxil) as particularly potent in this regard, citing a previous study that found a statistically significant link.
In general, however, the two scientists concluded that prospective plastic surgery patients should continue taking antidepressants as needed. Through their research, the team confirmed that the benefits of these drugs far outweigh the possible slight risks, and they call for more study to clarify their results.
Implications for Plastic Surgeons
For plastic surgeons, the study is good news. It means that there’s little indication that patients should stop taking antidepressants in order to have a procedure, thereby maintaining a healthy outlook that can aid in smooth preparation and recovery.
But the study does not change the fact that plastic surgeons should probe when they discover a patient is taking an antidepressant. As the researchers note, it’s important for the doctor to understand why the patient takes such a medication, as well as how effective it is for them and so on. Any hint of ongoing depression, emotional issues, relationship problems or body dysmorphia should be an immediate red flag. If there’s uncertainty, the plastic surgeon can request a letter from or conversation with the prescribing doctor.
Implications for Patients
The study is good news for patients too. There’s probably no need to consider suspending the use of medication that’s helpful, especially during a time when they may feel a bit of extra stress. That said, prospective plastic surgery patients who take antidepressants should:
• Check with their primary care doctor to see how he or she feels about their particular prescription and surgery, and inquire whether further safety information may have been published
• Examine their motivations for plastic surgery carefully to be sure expectations are in line with the results that are actually likely
• Tell their plastic surgeon about the medication, and be prepared for a discussion about their emotional health and readiness for a procedure
In most cases, then, doctors and patients do not need to be overly concerned about the implications of antidepressant medication on physical plastic surgery risks. Assuming the conclusions of the study continue to be borne out by further research, risks that need to be assessed for these patients lie more often in the psychological realm.
