Do you take antidepressants? For most people, this is not a problem around an eyelid surgery. Even so, there are two points of attention we would like to share with you: a possibly increased risk of bleeding with SSRIs and SNRIs, and an important interaction with (the rarely used) MAO inhibitors.
Which medication does this concern?
- SSRIs: sertraline, paroxetine (Seroxat), fluoxetine (Prozac), citalopram, escitalopram
- SNRIs: venlafaxine (Efexor), duloxetine
- Tricyclic antidepressants: amitriptyline, nortriptyline
- MAO inhibitors (rare): phenelzine, tranylcypromine, and selegiline, which is used for Parkinson’s
Why is this relevant?
SSRIs and SNRIs reduce the storage of serotonin in blood platelets, which can affect platelet function. Research shows that the use of SSRIs can increase the risk of bleeding complications during and after an operation [1,2,3].
This does not mean that you have to stop your antidepressants: the risk of relapse, withdrawal symptoms or a return of depressive complaints when stopping is generally considered greater than the (small) increased bleeding risk. The decision to stop is therefore rarely made, and certainly not without consultation with the prescribing doctor [1].
MAO inhibitors are a separate category: these products can have an interaction with certain substances, including adrenaline (epinephrine), which is sometimes added to local anaesthetic. Modern insights show that local anaesthesia with careful dosing and monitoring is often still possible with MAO inhibitors, but this requires extra attention [4].
Discuss it in a personal consultation with plastic surgeon David Jairath, at our clinic for eyelid surgery in Haarlem. A first consultation can usually take place within a week.
Points of attention
- SSRIs and SNRIs can slightly increase the bleeding risk, especially in combination with blood thinners or NSAIDs [1,2,3]
- Never stop antidepressants on your own initiative before a procedure
- Are you using an MAO inhibitor? Always report this; this is rare, but requires an adjusted anaesthetic [4]
Our protocol at Kliniek het Bolwerk
1. Extensive medical history
We ask about your antidepressants, including the name of the product and any combination with other medication such as blood thinners or NSAIDs.
2. Continuing medication
SSRIs, SNRIs and other antidepressants are, as a rule, simply continued [1].
3. Adjusted anaesthetic with MAO inhibitors
In the case of use of an MAO inhibitor, we adjust the anaesthetic: careful, measured administration and monitoring during the procedure [4].
4. Extra attention with combination with blood thinners
Are you using an SSRI or SNRI together with blood thinners or platelet inhibitors? Then we take extra account of this with the surgical technique [3].
Important: never stop antidepressants on your own initiative. Are you using an MAO inhibitor (such as phenelzine, tranylcypromine or selegiline)? Always report this; this is an important point of attention for the anaesthetic.
When do we advise against the procedure (for the time being)?
- Not on the basis of SSRI or SNRI use alone
- In the case of a combination of an SSRI/SNRI with blood thinners and other bleeding risks, without consultation [3]
- If the prescribing doctor advises against the procedure at this time
Our advice
Are you using antidepressants? Mention this on your medication list during the intake consultation at Kliniek het Bolwerk. Are you using an MAO inhibitor? Then report this in particular, so that we can adjust the anaesthetic accordingly.
Literature references
The publications below form the medical-scientific basis of this article:
- The publications below form the medical and scientific basis of this article: 1. Selective Serotonin Reuptake Inhibitors and Operative Bleeding Risk: A Review of the Literature. PubMed. 2016. https://pubmed.ncbi.nlm.nih.gov/27684291/
- Serotonin reuptake inhibitors and bleeding risks related to elderly submitted to major orthopedic surgery. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777648/
- Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis. Annals of Medicine (PMC). 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725830/
- MAO Inhibitors: Anesthetic Interactions. OpenAnesthesia. 2026. https://www.openanesthesia.org/keywords/mao-inhibitors-anesthetic-interactions/
