Antidepressants in Spine Surgery: A Systematic Review to Determine Benefits and Risks

Abstract

Antidepressant drugs can be advantageous in treating psychiatric and non-psychiatric illnesses, including spinal disorders. However, spine surgeons remain unfamiliar with the advantages and disadvantages of the use of antidepressant drugs as a part of the medical management of diseases of the spine. Our review article describes a systematic method using the PubMed/Medline database with a specific set of keywords to identify such benefits and drawbacks based on 17 original relevant articles published between January 2000 and February 2018; this provides the community of spine surgeons with available cumulative evidence contained within two tables illustrating both observational (10 studies; three cross-sectional, three case-control, and four cohort studies) and interventional (seven randomized clinical trials) studies. While tricyclic antidepressants (e.g., amitriptyline) and duloxetine can be effective in the treatment of neuropathic pain caused by root compression, venlafaxine may be more appropriate for patients with spinal cord injury presenting with depression and/or nociceptive pain. Despite the potential associated consequences of a prolonged hospital stay, higher cost, and controversial reports regarding the lowering of bone mineral density in the elderly, antidepressants may improve patient satisfaction and quality of life following surgery, and reduce postoperative pain and risk of delirium. The preoperative treatment of preexisting psychiatric diseases, such as anxiety and depression, can improve outcomes for patients with spinal cord injury-related disabilities; however, a preoperative platelet function assay is advocated prior to major spine surgical procedures to protect against significant intraoperative blood loss, as serotonergic antidepressants (e.g., selective serotonin reuptake inhibitors) and bupropion can increase the likelihood of bleeding intraoperatively due to drug-induced platelet dysfunction. This comprehensive review of this evolving topic can assist spine surgeons in better understanding the benefits and risks of antidepressant drugs to optimize outcomes and avoid potential hazards in a spine surgical setting.

Dementia, Depression, and Associated Brain Inflammatory Mechanisms after Spinal Cord Injury

“…As described above, depression is associated with decreased physical activity and increased risk of developing dementia [ 139 , 140 ]. Anti-depressant drugs can be advantageous in treating SCI-mediated depression, including improving mood status and quality of life following surgery, and reducing risk of delirium and suicide [ 141 ]. Venlafaxine may be more appropriate for patients with SCI presenting with depression and/or nociceptive pain [ 142 , 143 , 144 ].…”

Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review

“…49 In a recent realworld, cohort study of five million surgical patients over a ten-year period, concomitant use of gabapentinoids with opioids was associated with an increased risk of opioid overdose and other opioid-related adverse events; however, the absolute risk of adverse events was low (number needed to treat for additional overdose to occur was more than 16,000 patients). 50 Other non-opioid medications with less established evidence base for post-operative pain management following spine surgery include antispasmodics, antidepressants, [51][52][53] melatonin, 54 vitamin C, 55 and cannabinoids. 56…”

Functional outcome in operated patients of multilevel lumbar canal stenosis and use of HRQoL role in depicting the anxiety and its correlation with the pain

“…We have not used any drug therapy for combating depressive features during the treatment, even in the postoperative period. There is no consensus in the literature regarding the use of antidepressant drug in the spinal surgery patient and few risk factors as decreased platelet aggregation, chances of bleeding and poor bony fusion has been reported in the previous articles but more extensive randomized control trial are needed to prove the benefits and risk factors [25,26]. Many studies have shown that about 20-40% of the LCS patients have clinically significant depressive symptoms.…”