Topic 8: Depressive Disorders

Medications that help treat depressive disorders

• SSRIs

• Atypical Antidepressants

• Tricyclic Antidepressants

• MAOIs

example of SSRI (depressive disorder)

fluoxetine

fluoxetine (SSRI) action

increases serotonin in system

T or F: fluoxetine (SSRIs) take immediate effect

T or F: fluoxetine (SSRIs) can take four weeks to produce therapeutic medication levels

fluoxetine (SSRIs) complications

sexual dysfunction, weight gain, serotonin syndrome, inability to sleep

fluoxetine (SSRIs) therapeutic uses

OCD, trauma, depressive disorders

fluoxetine (SSRIs) nursing considerations

taper dose due to possible dependence

atypical antidepressant example

buproprion & trazodone

bupropion (atypical antidepressant) use

aids in smoking cessation

bupropion (atypical antidepressant) complications

h/a, GI distress, insomnia, nausea, vomiting, weight loss, seizures

trazodone (atypical antidepressant) adverse effect

sedation

example of tricyclic antidepressant

amitriptyline

amitriptyline (tricyclic antidepressants) therapeutic use

depression, neuropathic pain, fibromyalgia, anxiety disorders, insomnia

amitriptyline (tricyclic antidepressants) complications

anticholinergic effects, tachycardia, sedation, decreased seizure threshold, excessive sweating, orthostatic hypotension, cardiac toxicity

anticholinergic effects

• can’t pee

• can’t see

• can’t spit

• can’t shit

cardiac toxicity

• dysrhthmias

• mental confusion

• agitation

• seizures

• coma

• death

amitriptyline (tricyclic antidepressants) nursing considerations

• chew sugarless gum

• wear sunglasses

• eat high fiber foods

• increase fluid intake

MAOI example

phenelzine

phenelzine (MAOI) therapeutic use

depression

phenelzine (MAOI) complications

CNS stimulations (agitation, anxiety), hypotension) & hypertensive crisis

phenelzine (MAOI) interactions

• MOST meds

• tyramine-rich foods

tyramine-rich foods

• aged cheese

• salami

• avocado

• pepperoni

• figs

• bananas

• smoked fish

• protein dietary supplements

• soups

• soy sauce

• red wine

• some beers

phenelzine (MAOI) interaction with tyramine-rich foods results in

hypertensive crisis

phenelzine (MAOI) client education

• other medications must be approved by provider

• avoid tyramine-rich foods

• dietary restrictions should continued for 2 weeks after MAOI has been discontinued

• avoid caffeinated beverages/chocolate/gava beans/ginseng

• do not use within 10-14 days before/after surgery

• can take 1-3 weeks to begin experiencing effects and full effects can take 2-3 months

• sudden discontinuation can result in relapse

• therapy usually continued for 6m-1y after symptoms have resolved

• assess for suicide