Do I need to stop taking antidepressants before BBL?

Question

I have been on Zoloft since February for panic attacks and I am on 25mg. My patient coordinator said it's safe but the contract says to stop. I am scared to get a panic attack on the table. Do I need to stop or can I continue taking them?

Kenneth Hughes, MD · Answer

Many patients who are on a wide variety of antidepressant medications undergo cosmetic surgery. Taking these medications will not prevent your from having a BBL. Your plastic surgeon may ask for a medical clearance from your psychiatrist or the specialist who is treating you for panic attacks. The dosage you are taking is considered low.

Daniel Barrett, MD · Answer

Dear ethanar123,
every plastic surgeon has his own preoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

The fact that you haven’t met with a plastic surgeon and have scheduled surgery is a bit disturbing.

Are you planning on having your procedure at Sono Bello?

If so I believe their policy is to have a preop visit with the physician before your date of surgery.

The reason some clinics or providers ask patients to not take mental health medications before Liposuction is generally related to this being done as an awake procedure using primarily local anesthesia as a form of anesthetic.

The primary local anesthetic used is called lidocaine. This drug is used in very high doses and can potentially be toxic in very high doses such as those used for Liposuction.

Lidocaine is processed in the liver by an enzyme called P450.

The same enzyme is responsible for the breakdown of many drugs including many psychiatric medications.

For patients to take medications to compete with the P4 50 enzyme the breakdown of lidocaine can be delayed increasing the risk of developing systemic lidocaine toxicity which can in its worst case scenario become fatal.
We have good Scientific evidence of what are considered safe lidocaine limits but some providers will adjust these if patients are currently taking medications to compete with a P4 50 enzyme system.

Ideally this should all be discussed during an in person consultation with a board-certified plastic surgeon.

If that didn’t happen then I suggest asking yourself if this is really the appropriate place to have surgery?

Have you read the reviews for this clinic or provider?

Plastic surgeons who use an anesthesiologist or general anesthesia for the procedure don’t need to worry about these concerns.

One of the issues with simply telling people to stop taking psychiatric medication is that the consequences of doing so can also be fatal.

The impact of simply stopping psych meds without the input of a psychiatrist can be foolish and potentially dangerous.

These are not decisions that commission sales people should be making.

These are decisions that should be made By the treating physician.

Perhaps having a few second opinions is in order.

Best,

Mats Hagstrom MD

Do I need to stop taking antidepressants before BBL?

Answers (3)

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