Antidepressants and facial harmonization: is it a problem?

The short answer: a patient taking an antidepressant can generally have botox and filler, and use is not an automatic reason to decline. Two points call for attention. The first is physical: some antidepressants can make bruising easier. The second is human: the procedure does not treat depression and the patient's motivation needs to be discussed with care. And you never ask them to stop the medication.

This page helps you conduct that consultation with respect, without stigma and without overstepping your role. For assessing motivation and expectations, see also body dysmorphic disorder in HOF and when to refer to psychology.

Does the antidepressant get in the way of the procedure?

As far as the effect of hyaluronic acid and botulinum toxin goes, there is no indication that commonly used antidepressants cancel the result. What exists in the literature is an association of certain classes (selective serotonin reuptake inhibitors, SSRIs, and a few others) with a greater tendency to bleed, because serotonin takes part in platelet aggregation. In office practice, this translates into a possibly higher chance of bruising and ecchymosis.

This is not a contraindication. It is a reason to:

• record the medication in the medical history;
• tell the patient that bruising may be more likely;
• avoid adding other factors that promote bleeding unnecessarily, such as aspirin and anti-inflammatories without checking first (see aspirin before filler);
• schedule with room to spare if there is a social event coming up.

What to ask and what to record

The conversation works best when it is simple and nonjudgmental: "Do you take any ongoing medication, including for mood or anxiety?". If the answer is yes, ask for the name, how long they have taken it and whether the treatment is stable.

A recent change of medication or dose is a sign to wait for the patient to stabilize. See also patient who withholds information in the medical history in case the person is reluctant to say.

Mental health, decision and consent

The delicate point is not the antidepressant but the timing. Some questions help assess whether the decision is being made clearly:

• Is the request longstanding, or did it come up after an event (breakup, bereavement, job loss, crisis)?
• Does the patient expect the procedure to change their mood, relationship or job?
• Is the discomfort with their appearance disproportionate to what you observe?
• Can they hear "I wouldn't do that" without falling apart?

If the answers point to significant distress, the best service is to say frankly that the procedure does not solve that, offer a pause and suggest mental health care. Signing informed consent with a clear mind is part of good care; see how to explain the consent form.

Bruising more likely: how to plan

For immediate aftercare, see aftercare for lip filler and aftercare for botox.

What to say about expectations

Patients in mental health treatment may be more sensitive to the result. A few attitudes protect the relationship:

• Show the plan visually and agree on what will and will not be done. In Harmy, that is the projection on the slider.
• Reinforce that the result is gradual and that touch-ups are part of it, without promising.
• Avoid the phrase "it will improve your self-esteem". Prefer "let's soften this spot that bothers you".
• Give time to decide and a way to ask questions, without pushing to close.

When to refer or postpone

Postpone and refer when there are signs of acute distress, thoughts of death or self-harm (in which case the priority is to seek immediate help, such as an emergency service), a recent change of medication, or a request that seems to be an attempt to resolve a crisis. Record the conversation in the patient record. If declining is warranted, see saying no to a patient with suspected dysmorphia.

Where does Harmy come in?

Harmy does not assess mental health or medication. It helps turn the request into a visible plan: you mark a few areas, choose volume and intensity and show the projection, which helps the patient see that the result is subtle and decide without rushing. It is an illustrative simulation, not a promise of results.