Mental Health - Antidepressant Therapy
Terms
undefined, object
copy deck
- Antidepressant Medication Target Symptoms:
-
1. Fatigue
2. Decreased Sex Drive
3. Anhedonia (loss of interest/pleasure)
4. Sleep Disturbance
5. Appetite Disturbance
6. Diurnal Variations in Mood - Mechanism of Antidepressants:
-
- not completely understood
- acts as the neurotransmitter level
- works similar to antipsychotics - affects neurotransmitters but exact reason is unknown - Antidepressant Drugs:
-
1. SSRI's
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Citalopram (Celexa)
2. MAOIs
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Isocarboxazid (Marplan)
3. Tricyclic (TCAs)
- Imipramine (Tofranil)
- Amitriptyline (Elavil)
- Doxepin (Sinequan)
- Clomipramine (Anafranil)
- Trimipramine (Surmontil)
4. Novel (atypical)
- Bupropion (Wellbutrin, Zyban) - smoking sensation agent; nicotine - give patient Zyban; Wellbutrin - decreases seizure threshold
- Trazodone (Desyrel)
- Venlafaxine (Effexor) - SNRIs (Serotonin & norepinephrine inhibitors) - Safety concern with Antidepressants
-
- antidepressants & suicide risk (increased risk)
- overdose of MAOIs & Tricyclic antidepressants (lethal)
- use caution: drug interactions with tricyclic antidepressants & MAOIs (can't be given together because of negative interaction)
- MAOIs - hypertensive crisis (monitor BP) - can cause severe headache
- MAOIs - restrict intake of TYRAMINE (ex. fermented meats, cheeses, fish, beer, wine, bananas, sour crout) - must maintain this diet for 14 DAYS after! - Sedative drugs & Drug Interaction (SSRI + MAOI)
-
*sedative drugs should be taken at night
*body must be cleaned for at least 10 days before switching to MAOIs; serious reaction can occur if SSRI is given with MAOI - possibly death! - Caution with MAOIs (Antidepressants)
-
MAOIs cannot be mixed with:
1. MAO antidepressants
2. SSRI antidepressants
3. Meperidine (Demerol)
4. Buspirone (Buspar)
5. Over the counter medications (for colds, allergies or congestion) - Caution with TCAs (Antidepressants)
-
TCAs cannot be mixed with:
1. Barbiturates
2. Alcohol
3. Benzodiazapines (can get withdrawal symptoms - ex. anxiety)
4. Nicotine - Nurses Role regarding TCA
-
- assessment & family/patient teaching
- patient reassured that drowsiness, dizziness & hypotension usually subsides after first few weeks
- avoid machinery
- avoid alcohol (blocks effects of antidepressants)
- do not suddenly stop - consult physician (dangerous - may cause cardiac issues & rebound anxiety; can cause nightmares; similar to withdrawal)
- side effects: erectile dysfunction
*educate patients by verbally speaking & providing written information - Nurses role regarding SSRI's
-
- family/patient teaching regarding adverse effects (sexual dysfunction, nausea, dry mouth, diarrhea)
- liver & renal function tests
- medications should not be discontinued abruptly (taper)
- meds may cause anxiety, insomnia & nervousness
- SEROTONIN SYNDROME symptoms - rare (ex. restlessness, hyperactivity, hypertension, seizures)
- avoid alcohol (a lot of products may contain alcohol)
- report symptoms to physician - rash or hives, sore throat, severe headache, difficulty urinating, tachycardia, unusual bleeding
- avoid over the counter drugs
- SSRI's should be taken FIRST thing in the morning - unless SEDATION is a problem
- it takes approximately 24 hours for alcohol to clear the body - Sedatives, Hypnotics & Antiolytics
-
- class all CNS depressants
- effects: symptoms of intoxication & withdrawal similar to those of alcohol
- include barbiturates & nonbarbiturate hypnotics
- Barbiturates: lethal when taken in overdose (ex. Phenobarbitol)
- Anxiolytic Agents (Antianxiety):
-
- Diazepam (Valium)
- Clonazepam (Klonopin)
- Alprazolam (Xanax)
- Lorazepam (Ativan)
*Xanax and Ativan are very dependent drugs
*CHLOHYDRATE: less side effects - recommended
*discontinuation requires tapering
*some have hypnotic effects (sleep-inducing)
*Fluraepam (Dalmane)
*Temazepam (Restoril)
- potentiate the ability of GABA - Anxiety Agent
-
- Buspirone (Buspar) - serotonin agonist
- reduces anxiety but not strong sedative-hypnotic properties
- better tolerated than other benzodiazepines
- not a CNS depressant
- potential for addiction
- used to treatment: OCD (obsessive compulsive disorder)
*don't take with food - slows absorption - Anxiety Agents (Treatment):
-
- anxiety & anxiety disorders
- OCD
- Depression
- PTSD (post traumatic stress disorder)
- alcohol withdrawal (Chlordiazepoxide)
- Sleep disorders
- quick onset of action
- physical dependence
- vary in terms of their half-life (how it is metabolized)
- SHORTER half-life get "rebound effects" - restlessness & agitation - Nurses Role with regards to antianxiety agents:
-
- patient & family teaching
- not to increase dose or frequency
- avoid use of machinery
- avoid the use of alcohol or other anxiety agents
- avoid caffeine
- cause congenital anomalies - pregnancy (avoid)
- no breastfeeding (drugs excreted in breast milk)
- cessation (3-4 months) withdrawal symptoms can be fatal
- antacids - delay absorption (give 1 hour before or 2 hours after administration)
- suggest to take meds with meals (prevent GI upset)
- tapered gradually
- sedation, drowsiness
- decreased concentration