Chapter 23 Antidepressants & Mood stabilizers

whats depression

genetic predisposition, social and environmental factors

decrease levels of monoamine neurotransmitters

Women 25-45 2-3x more likely than men to experience depression

Depressed men, older Caucasian, are more likely to commit suicide successfully

what are signs and symptoms of depression

depressed mood, depair, weight loss or gain

decrease ability to think or concentrate

loss of interest in activities, fatigue, loss of energy

insomnia, hypersomnia, suicidal thoughts

what are the types of depression

-major depression (2 types)

primary: health problems

secondary physical or psychiatric disorder or drug use

-reactive depression

-bipolar disorder

whats reactive depression

usually sudden onset after a precipitating event, death of a loved one, usually lasts for month

what is bipolar disorder

mood swings between manic (euphoric) and depressive (dysohoric)

whats major depression

may be primary or secondary types

depressed mood, depair, weight loss or gain

decrease ability to think or concentrate

loss of interest in activities, fatigue, loss of energy

insomnia, hypersomnia, suicidal thoughts

what are the complementary/ alternative therapies for depression

Ginkigo biloba and St John wort (can interact with SSRIs and can cause serotonin syndrome)

what are the types of medication of major antidepressant

tricyclic antidepressants TCAs

selective serotonin reuptake inhibitors SSRIs

serotonin norepinephrine reuptake inhibitors SNRIs

atypical antidrepressants

monoamine oxidase inhibitors MAOIs

Tricyclic antidepressants TCA

use for major depression

blocks norepinephrine, serotonin, histamine, cholinergic resceptors

elevates mood, ADLs, decreases insomnia

causes sedation, hypotension, anticholinergic effects, and cadiotoxicity 

Blood dyscrasias (leukopenia, thrombocytopenia, and agranulocytosis)

Therapeutic serum ranges monitored

2-4 weeks duration for effect

Selective serotnin reuptake inhibitors SSRI 

Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram

Therapeutic effect:  3-4 weeks

blocks serotonin into nerve terminal of the CNS, enchancing serotonergic synapse

USED for major depression, anxiety disorders, prevent migraine, decrease premenstrual tension syndrome, eating disorders, substance use disorders

may experience sexual dysfunction, insomnia, dry mouth, blurred vision, suicidal ideation

Serotonin norepinephrine reuptake inhibitors SNRI

inhibit serotonin and norepinephrine

USED for major depression, generalized anxiety disorder, social anxiety disorder

side effect: drowsiness, dizziness, insmnia, blurred vision, amnesia, erectile/ejaculation dysfunction

adverse reaction: tachycardia, hypertension, othostatic hypotension, seizures, NMS, suicidal ideation

ex. Duloxetine, Desvenlafaxine

Amitriptyline

TCA medication

for agitated depression becuase of highly seedative effec

give at nighttime

decress gradually to avoid withdrawal symptoms 

what are some interaction with TCA medications

alcohol, cns depressant

maois= toxic psychosis, cadiotoxicity

antihyriod drugs= dysrhythmias

what are some interaction with SSRIs medications

increases sedation with alcohol and other depressants

grapejuice leads to toxicity

Fluoxetine

Sertraline

Paroxetine

Citalopram

Escitalopram

Duloxetine

Desvenlafaxine

Atypical antidepressants

affects serotonin, norepinephrine, and dopamine transmitters

USED major depression, reactive depression, anxiety

side effect: dry mouth, blurred vision, othostatic hypotension, dizziness, palpitations, tachycardia, constipation, erectile/ejaculatory dysfunction

ex. amoxapine, maprotiline

Amoxapine

Maprotiline

Monoamine oxidase inhibitors MAOIs

blocks enzymes mao that inactivates norepinephrine, dopamine, epinephrine, serotonin

USED depression

side effects: dizziness, drowsiness, peripheral edema, headache, weight gain, insomnia, anticholinergic effects, orthostatic hypotension, suicidal ideation

only 1% of patients take this type of medication due to many food interaction

what are some interaction with MAOI medication

cns stimulants: vasoconstrictors, cold medications causing hypertensive crisis

tyramine foods:  Some cheeses, cream, yogurt, coffee, chocolate, bananas, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, and red wines can cause a hypertensive crisis.

Nurse considerations:  blood pressure monitoring is essential, foods/OTC drugs to avoid

what are the interaction with atypical antidepressant medication

MAOIs medication

what type of mood stabilizer mediation we use

Lithium

Lithium

the first drug used for this disorder

alteration of ion transport in muscle and nerve cells, increase sensitivity to serotonin

USED bipolar disorder, manic episode

Has a calming effect causing some memory loss and confusion

monitored biweekly or least 1-2 months on maintance dose

monitor sodium levels

therapeutic serum NAROW: 0.8-1.2 mEq/L

TOXICITY greater 1.5 mEq/L

what are the side effect and adverse reactions of litium

dry mouth, thirst, polyuria (loss of water and sodium in increased urination), weight gain, metallic taste, and peripheral edema of the hands and ankles—can be annoying to the patient.

If taken during pregnancy, lithium may have teratogenic effects.

what are some interactions of lithium

nonsteroidal antiinflammatory drugs (NSAIDs) should not be given together, because NSAIDs may increase lithium levels.

Caffeine and loop diuretics may decrease lithium levels.

patients who have a cardiovascular disease due to an increased risk of lithium toxicity.

Caution must also be used in patients with thyroid disease, as hypothyroidism may occur.