antidepressant and mood stabilizers

What neurotransmitters are decreased in depression according to the monoamine theory?

Norepinephrine, serotonin, and dopamine.

What is reactive depression?

Depression with sudden onset after a precipitating event, such as the death of a loved one.

What is a hallmark feature of bipolar disorder?

Mood swings between manic and depressive episodes.

Which herbal supplement commonly used for depression should be stopped 1-2 weeks before surgery?

St. John's Wort.

What are the five major classes of antidepressants?

TCAs, SSRIs, SNRIs, atypical antidepressants, and MAOIs.

How do tricyclic antidepressants (TCAs) work?

They block the reuptake of norepinephrine and serotonin.

Why do TCAs commonly cause sedation?

They block histamine receptors.

Why do TCAs cause anticholinergic effects?

They block cholinergic receptors.

What are classic anticholinergic side effects seen with TCAs?

Dry mouth, blurred vision, constipation, and urinary retention.

What cardiovascular adverse effects can occur with TCAs?

Orthostatic hypotension, cardiotoxicity, and dysrhythmias.

What substance should be avoided while taking TCAs because it increases CNS depression?

Alcohol

What is the primary mechanism of SSRIs?

They block serotonin reuptake

Besides depression, what psychiatric disorder are SSRIs commonly used to treat?

OCD (also anxiety disorders, PTSD, panic disorders).

Which juice can increase SSRI toxicity?

Grapefruit juice.

What SSRI side effects are highly testable?

Headache, insomnia, GI distress, dry mouth, erectile dysfunction, and suicidal ideation.

How long do SSRI side effects often take to decrease?

About 1-4 weeks

How do SNRIs work?

They inhibit reuptake of serotonin and norepinephrine.

What anxiety disorders are SNRIs commonly used for?

Generalized anxiety disorder and social anxiety disorder.

Which cardiovascular adverse effects are associated with SNRIs?

Tachycardia, hypertension, and orthostatic hypotension.

Which neurotransmitters are affected by atypical antidepressants?

Serotonin, norepinephrine, and dopamine.

For what type of depression are MAOIs typically reserved?

Depression not controlled by TCAs or second-generation antidepressants.

Why are MAOIs effective for depression?

They prevent breakdown of norepinephrine, dopamine, epinephrine, and serotonin

What life-threatening reaction can occur when MAOIs are combined with sympathomimetic drugs such as pseudoephedrine?

Hypertensive crisis.

What specific dietary restriction is critical for patients taking MAOIs?

Avoid tyramine-containing foods.

Name three high-yield tyramine-containing foods.

Aged cheeses, red wine, and soy sauce.

What is the most dangerous food-drug interaction associated with MAOIs?

Tyramine ingestion causing hypertensive crisis.

What is the therapeutic serum lithium range?

0.8-1.2 mEq/L.

At what lithium level does toxicity become likely?

Greater than 1.5 mEq/L.

What is the primary use of lithium?

Bipolar disorder and manic episodes.

What are common lithium side effects professors often test on?

Tremors, excessive thirst, dry mouth, metallic taste, increased urination, and GI distress

Why is dehydration dangerous in patients taking lithium?

It can increase lithium levels and contribute to toxicity.

Which substances decrease lithium levels?

Caffeine, loop diuretics, and theophylline.

What patient teaching is essential regarding sodium intake while taking lithium?

Maintain adequate and consistent sodium intake.

What laboratory value is especially important to monitor in a patient taking lithium?

Serum electrolytes (especially sodium).

A patient on fluoxetine reports headaches and insomnia. What should the nurse do?

Explain that these are common SSRI side effects