Decoding the Neurochemical Crossroads: Evidence-based Perioperative Management of Patients on Psychotropic Medications

Psychotropic medications are widely prescribed for various psychiatric disorders, and the management of these medications during the perioperative period presents significant challenges for anesthesiologists and surgeons. This review examines current evidence regarding the perioperative management of patients on various psychotropic medications including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. Recent randomized controlled trials, meta-analyses, and systematic reviews published through 2024 were reviewed to provide updated recommendations. Continuation of most psychotropic medications through the perioperative period is now supported by substantial evidence, with specific exceptions for monoamine oxidase inhibitors and certain mood stabilizers. Potential drug interactions, withdrawal syndromes, and hemodynamic effects require careful consideration and individualized approaches. Preoperative psychiatric consultation, risk stratification based on both surgical and psychiatric factors, and clear communication between surgical and psychiatric teams are essential components of optimal care. This review highlights evidence-based strategies to minimize perioperative risks while maintaining psychiatric stability in this vulnerable patient population.