The Pervasive Nature of Pre-Surgery Anxiety
Feeling anxious before a surgical procedure is an extremely common and normal response [1.7.3]. The prospect of anesthesia, the surgery itself, and the recovery process can create significant stress. This preoperative anxiety isn't just an unpleasant emotion; it can have tangible effects on surgical outcomes. Research shows that high levels of anxiety can lead to an increased need for anesthetic and analgesic drugs, prolonged recovery times, and a higher risk of postoperative complications like pain and nausea [1.8.2, 1.8.3]. For this reason, managing anxiety is a critical part of preparing for surgery. Many patients who are already on medication for anxiety disorders face the crucial question of how to manage their prescriptions in the days leading up to their operation.
The Golden Rule: Full Disclosure to Your Medical Team
The most critical step for any patient is to have a thorough discussion with their surgeon and, most importantly, the anesthesiologist about all medications they are taking [1.9.3]. This includes prescribed anxiety medications, over-the-counter drugs, vitamins, and herbal supplements [1.2.2]. Never assume a medication is harmless. Certain substances can interact dangerously with anesthetic agents, affect blood clotting, or alter blood pressure during a procedure [1.6.2, 1.3.1]. The decision to continue or temporarily stop a medication is a personalized one that only your healthcare team can make based on your specific health profile, the type of surgery, and the medications in question [1.2.1].
Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SSRIs (like fluoxetine and sertraline) and SNRIs are among the most common medications for anxiety and depression. The general consensus is that these medications should be continued throughout the perioperative period [1.4.1]. Abruptly stopping them can lead to discontinuation syndrome, which includes symptoms like dizziness and confusion that could be mistaken for postoperative complications [1.4.1]. While there is some evidence that SSRIs can slightly increase bleeding risk, the dangers of stopping the medication and risking withdrawal or a relapse of depression/anxiety are generally considered greater [1.3.5, 1.4.3]. Your anesthesiologist will factor your SSRI/SNRI use into their plan.
Benzodiazepines (Benzos)
This class of drugs, which includes alprazolam (Xanax) and lorazepam (Ativan), is often used for acute anxiety [1.2.3]. The guidance here is more complex. On one hand, anesthesiologists may administer a benzodiazepine right before surgery to calm a patient [1.2.2, 1.2.6]. However, if you take them chronically, it's a different situation. Chronic use can increase the amount of anesthesia required, while acute use can decrease it [1.3.4]. They also have a synergistic effect with opioids and other anesthetics, which can lead to excessive sedation and respiratory depression [1.3.2, 1.3.4]. If you are a regular user, it is vital to discuss this with your anesthesiologist. Abruptly stopping can also cause withdrawal [1.3.6]. The decision will be tailored to you.
What About Herbal Supplements and OTC Products?
Many herbal supplements taken for anxiety can have potent and dangerous interactions with anesthesia. Products like St. John's Wort, Kava, and Valerian root must be stopped, typically one to two weeks before surgery [1.6.1, 1.6.2]. For example, St. John's Wort can prolong the effects of anesthesia, while Kava and Valerian can increase sedation to risky levels [1.6.2]. Always provide a complete list of all supplements to your care team.
Comparison of Anxiety Medication Guidelines for Surgery
| Medication Class | Common Examples | General Pre-Surgery Guideline | Key Anesthetic Consideration |
|---|---|---|---|
| SSRIs/SNRIs | Fluoxetine, Sertraline, Venlafaxine | Usually Continued [1.4.1] | Risk of withdrawal syndrome if stopped; slight potential for increased bleeding [1.3.5, 1.4.1]. |
| Benzodiazepines | Alprazolam, Lorazepam, Diazepam | Discuss with Anesthesiologist [1.3.6] | Can be used as premedication, but chronic use alters anesthetic needs and can increase sedation [1.3.4]. |
| Beta-Blockers | Propranolol, Metoprolol | Usually Continued [1.9.1] | Abruptly stopping can cause dangerous changes in heart rate and blood pressure. |
| MAOIs | Phenelzine, Isocarboxazid | Often Stopped 2 Weeks Prior [1.4.1] | High risk of severe hypertensive crises and serotonin syndrome when interacting with certain anesthetic drugs [1.4.1]. |
| Herbal Supplements | St. John's Wort, Kava, Valerian | Must Be Stopped (1-2 Weeks Prior) [1.6.2] | Significant and unpredictable interactions, such as prolonged sedation or interference with drug metabolism [1.6.2, 1.6.4]. |
Conclusion: A Collaborative Decision
Ultimately, the answer to 'Can I take anxiety medicine before surgery?' is not a simple yes or no. It is a collaborative decision made between you and your medical team. The priority is ensuring your safety during and after the procedure. While untreated anxiety poses its own risks to your surgical outcome, undisclosed medication use can be far more dangerous. The safest path is always open and honest communication. Prepare a comprehensive list of every medication and supplement you take, and review it with your surgeon and anesthesiologist well before your surgery date. https://www.yalemedicine.org/news/anesthesia-opioids-anxiety-surgery-questions-answered
