Anesthetic implications of psychotropic medications: a narrative review

Psychotropic medications are widely used in the treatment of mental and nonmental disorders such as chronic pain and other off-label indications. With the increase in comorbidities of mental and physical illnesses, anesthesiologists more frequently encounter patients taking psychotropic medications who require surgical procedures. Commonly prescribed psychiatric medications include antidepressants, mood stabilizers, anxiolytics, and antipsychotics. These medications can interact with anesthetic agents or other drugs commonly used during anesthesia at both pharmacokinetic and pharmacodynamic levels, potentially precipitating life-threatening syndromes such as serotonin syndrome, neuroleptic malignant syndrome, and lithium toxicity. This review summarizes the current knowledge on the pharmacology of commonly prescribed psychiatric medications, including their adverse effects and interactions with anesthetic agents routinely used in the perioperative period. Additionally, considering the risk of withdrawal symptoms and psychiatric relapse or recurrence, current recommendations for the discontinuation or continuation of these medications during the perioperative period are discussed.