Management of Psychotropic Medications in Surgical Procedures

Abstract

The increasing prevalence of psychiatric disorders in the general population and the substantial rise in surgical interventions performed on this patient group have rendered perioperative psychotropic medication management a critical area of clinical practice. This narrative review comprehensively addresses current evidence regarding the management of antidepressants, antipsychotics, mood stabilizers, and various other psychotropic agent classes across the preoperative, intraoperative, and postoperative periods. Topics covered include relapse triggered by abrupt discontinuation, withdrawal syndromes, and pharmacokinetic interactions arising with anesthetic agents. How to achieve the balance between medication continuity and surgical safety, the criteria by which individualized risk–benefit analysis should be conducted, and how multidisciplinary team communication should be integrated into the perioperative process constitute the central discussions of this review. In particular, anticipating and managing drug-induced adverse effects such as QT prolongation, serotonin syndrome, and cholinergic blockade in the perioperative setting further underscores the necessity of a structured communication protocol between anesthesiologists and psychiatrists. This review also aims to contribute to the development of perioperative psychotropic management guidelines that have yet to be sufficiently standardized, and to provide clinicians with an evidence-based, practical reference framework. The available data indicate that the majority of psychotropic medications should be maintained throughout the surgical period; however, agents with a narrow therapeutic window, such as lithium, necessitate meticulous pharmacological planning prior to surgery.