People with chronic back pain also commonly suffer from depression. As a result, patients going in for spinal surgery are often taking antidepressant medications. Yet past research has shown that antidepressant use is associated with an increased risk of blood loss and need for transfusions during orthopedic procedures. A new study for the first time illuminates the impact of antidepressants on transfusion requirements in spinal surgery in particular.

The authors of the new work – a team from Hospital for Special Surgery (HSS) in New York City – reviewed the charts of 340 patients who undergone spinal fusion surgeries. They found a statistically significant association between the SSRI class of antidepressant and both increased bleeding and the need for perioperative blood transfusions.

"We set out to help define this phenomenon in a clinically significant fashion," comments lead study author Alexander P. Hughes, MD, spine surgeon at HSS. "We think our findings will help increase awareness of this risk factor among doctors so they can potentially modify their perioperative protocol."

Dr. Hughes explains that in patients undergoing spinal surgeries – especially higher risk procedures associated with more bleeding – perhaps patients can come off their SSRIs temporarily to reduce bleeding risk.

Given the increased rates of the depression in spinal surgery patients, Hughes acknowledges treating clinicians must balance the risks and benefits of stopping SSRIs in surgical patients.

"There needs to be a discussion between the patient and their clinical team, especially their psychiatrists and therapists," he says. "In patients with more minor depression, we’d be more willing to stop their antidepressant temporarily, say one week prior to surgery. In someone with severe depression, doing so might not be appropriate."