If you’re due for an operation, your doctor may have told you to stop taking anti-inflammatory drugs or your usual daily aspirin, for fear that these medications would increase bleeding during and after surgery. But did your doctor say anything about your antidepressant medication? If not, it’s definitely something you need to discuss.

The reason: Depression-relieving selective serotonin reuptake inhibitors (SSRIs) have been linked to some very serious complications for surgical patients—including a significantly increased risk of dying in the hospital—according to a huge new study. This is important news, especially considering that about 11% of Americans over age 12 take antidepressants.

The research: Using records from 375 US hospitals and more than 530,000 patients who had major surgery, researchers compared outcomes for people taking SSRIs (Celexa, Lexapro, Luvox, Paxil, Prozac, Symbyax and Zoloft) with those for people not taking the drugs. About 14% of the patients were taking SSRIs around the time of their surgery.

The worrisome results: Compared with patients who were not taking SSRIs, those who did take the drugs had a 9% higher risk for excess bleeding…a 22% higher risk of being readmitted to the hospital within 30 days of their operations…and a 20% higher risk of dying in the hospital during or soon after surgery.

Granted, patients who were taking SSRIs also were more likely to have other risk factors that predisposed them to surgical complications, such as obesity or chronic obstructive pulmonary disease (and of course, depression). To adjust for that fact, the researchers created a “data set” of matched patients—nearly 63,000 pairs of people who had nearly identical risk factors, with one person in each pair taking an SSRI and the other person not taking the medication. Comparing the data for these matched sets, the SSRI users were still 7% more likely to experience excess bleeding…18% more likely to be readmitted to the hospital…and 19% more likely to die.

Explanation: The increased surgical risks among SSRI users may be due to the fact that the drugs interfere with the normal functioning of platelets, blood cells that play a crucial role in clotting.

Now, this study showed only an association between SSRI use and increased risk for complications from major surgery. It did not prove that SSRIs cause such complications…nor did it look at the potential effects of other types of antidepressants on surgical risks. So unfortunately, there is not yet sufficient information to issue uniform guidelines on whether or when patients should stop taking antidepressants prior to surgery or on how soon afterward they might be resumed.

Bottom line: If you are anticipating elective surgery, do not simply stop taking your SSRI on your own—sudden discontinuation can lead to dizziness, nausea, aches, insomnia, anxiety and/or irritability. Your best bet is to speak with the physician who prescribes your antidepressant (or your primary care provider) and your surgeon about whether or not to taper off the medication, taking into consideration your other risk factors for surgical complications…the amount of bleeding your type of surgery typically involves…your use of any other medications that can increase bleeding…and the severity of your depression. In considering the pros and cons, also discuss the fact that SSRIs can reduce anxiety and physical pain—so in that regard, staying on the medication or resuming it shortly afterward could make your recovery after surgery significantly more comfortable.