The risk-to-benefit ratio must be considered before discontinuing a selective serotonin reuptake inhibitor (SSRI) in patients prior to an elective operative procedure, study authors concluded in a Journal of Clinical Psychopharmacology review.

Doctors Steven P. Roose and Bret R. Rutherford from Columbia University College of Physicians and Surgeons, aimed to review the data regarding the effect of SSRIs on bleeding during or post-operative procedures and to provide guidelines for clinical management. They searched PubMed and MEDLINE for studies that reported data on bleeding complications during operative or childbirth procedures in patients taking antidepressants. 

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Study authors found that the evidence pointed to an increased risk of bleeding complications during and immediately post-surgery with SSRI use. Due to limited data, however, the risk for a given patient having a given procedure could not be estimated. 

They noted that discontinuing an SSRI before an elective operative procedure may cause discontinuation syndrome, symptom recrudescence, depression relapse, but continuing an SSRI during surgery places patients at significant risk for bleeding. Clinicians should be aware and initiate discussions to address the problem and possible alternatives. 

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