What is the recommended duration prior to angiogram or surgical procedures that psych(iatric) medications can be safely discontinued?

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From the Research

Most psychiatric medications can be continued safely through angiogram or surgical procedures, but some require adjustment, and the decision to stop should be made in consultation with both the psychiatrist and the procedural specialist, considering the risk of psychiatric symptom recurrence against potential surgical complications. The timing for stopping psychiatric medications varies by medication class. Monoamine oxidase inhibitors (MAOIs) like phenelzine or tranylcypromine should be stopped 2-3 weeks before surgery due to potential dangerous interactions with anesthetics and pain medications 1. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, or escitalopram can typically be continued but may need to be stopped 1-2 weeks before procedures with high bleeding risk due to their mild antiplatelet effects 2.

Some key considerations include:

  • Benzodiazepines like diazepam or lorazepam should be tapered rather than abruptly discontinued to prevent withdrawal, with tapering beginning 1-2 weeks before surgery if discontinuation is necessary.
  • Lithium is usually held 24-48 hours before procedures involving contrast agents or where fluid/electrolyte shifts are expected.
  • Antipsychotics generally can be continued through most procedures, but recent studies suggest that discontinuation may be associated with a higher risk of relapse 3.
  • The decision to stop psychiatric medications requires careful consideration of the individual patient's condition, the type of procedure, and the potential risks and benefits of continuing or discontinuing medication, as highlighted in recent reviews of clinical guidelines and case examples 4.

It's also important to note that patients' experiences and strategies for discontinuing psychiatric medications can vary widely, and healthcare providers should be supportive and informative throughout the process 5. Ultimately, the goal is to balance the risk of psychiatric symptom recurrence against potential surgical complications, and to make informed decisions that prioritize the patient's overall health and well-being.

References

2
Research

Selective Serotonin Reuptake Inhibitors: How Long Is Long Enough?

Journal of psychiatric practice, 2021

5
Research

Discontinuing Psychiatric Medications: A Survey of Long-Term Users.

Psychiatric services (Washington, D.C.), 2017

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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