Anaesthesia for patients with mood disorders.

Area of Science:

• Anesthesiology and Pharmacology
• Mood Disorder Management

Background:

• Modern mood disorder pharmacotherapy has evolved, presenting challenges for anesthesiologists regarding premedication and anesthetic interactions.
• Older antidepressants (tricyclic antidepressants, monoamine oxidase inhibitors) are rarely used; newer agents are now standard practice.

Purpose of the Study:

• To review current antidepressant and mood stabilizer use in patients with mood disorders.
• To guide anesthesiologists on incorporating these medications into perioperative care and managing potential interactions.

Main Methods:

• Review of current literature on antidepressant and mood stabilizer use.
• Analysis of the impact of chronic antidepressant use on anesthetized patients.
• Discussion of anesthetic techniques for electroconvulsive therapy.

Main Results:

• Newer antidepressants (SSRIs, SNRIs, etc.) are common, often combined with antipsychotics or antiepileptics. Lithium and valproate remain first-line for bipolar disorder.
• Electroconvulsive therapy (ECT) is used for therapy-resistant depression, with improved anesthetic management described.
• Chronic antidepressant use can affect hemodynamics, thermoregulation, pain perception, and postoperative cognition; however, continuation is advised.
• Serotonin syndrome is a critical risk requiring anesthesiologist awareness.

Conclusions:

• Discontinuation of newer antidepressants perioperatively is not recommended.
• While intoxications with newer agents seem safer, anesthesiologists must monitor for serotonin syndrome.
• Electroconvulsive therapy is gaining renewed interest for specific depression cases.