Serotonergic Antidepressant Use After Recent Facial Burn Injury is Associated with Hypertrophic Scarring, Metabolic Complications, and Reduced Mortality

Facial burns can cause profound psychological distress, often treated with selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. While their psychiatric benefits are established, their impact on wound healing and long-term outcomes is less defined. This study examines associations between early serotonergic antidepressant exposure and physiological complications following facial burn injury. Adult patients with second- or third-degree facial burns (2010-2025) were identified in the TriNetX US Collaborative Network. Those prescribed antidepressants within one month of injury were compared to controls without antidepressant use. Propensity score–matching was performed based on demographics, burn characteristics, and psychiatric as well as medical comorbidities. Outcomes assessed at 90 days, 180 days, and 1 year included skin infection, hypertrophic scarring, lactic acidosis, hyperglycemia, hypoglycemia, and mortality. Univariate regression analyses were used to compare each outcome, with significance defined as P <.05. Of 46 971 facial burn patients identified, 3392 remained in each group after matching. Patients in the matched antidepressant group had significantly higher rates of hypertrophic scarring and skin infection at all time points compared to those in the matched control group (P <.01). Additionally, lactic acidosis and hyperglycemia became elevated beginning at 180 days (P <.05) among patients who were prescribed antidepressants. Mortality, however, was consistently lower in the matched antidepressant group at all time intervals (P <.05). Early serotonergic antidepressant use after facial burn injury is linked to increased risk of hypertrophic scar formation, infection, and metabolic disturbances, yet decreased rates of mortality.