Asian Spine J.  2019 Dec;13(6):1036-1046. 10.31616/asj.2018.0237.

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

  • 1Department of Neurosurgery, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey.
  • 2Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada.
  • 3Bahcesehir University School of Medicine, Istanbul, Turkey.
  • 4Department of Psychiatry, Medical Park Goztepe Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey.


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.


Spine surgery; Clinical outcomes; Antidepressive agents; Systematic review

MeSH Terms

Antidepressive Agents*
Antidepressive Agents, Tricyclic
Blood Platelets
Bone Density
Case-Control Studies
Cohort Studies
Duloxetine Hydrochloride
Length of Stay
Nociceptive Pain
Pain, Postoperative
Patient Satisfaction
Quality of Life
Risk Assessment*
Spinal Cord
Spinal Cord Injuries
Venlafaxine Hydrochloride
Antidepressive Agents
Antidepressive Agents, Tricyclic
Duloxetine Hydrochloride
Venlafaxine Hydrochloride
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