Antidepressants

Serotonin Selective Reuptake Inhibitors (SSRIs)

First line of drugs for depression. Inhibits reuptake of serotonin so it stays in the synapse longer and will take 1-3 weeks for effects. This can increase the risk for suicidal ideation and increase the risk of serotonin syndrome for the first 2-72 hours of starting

Side effects can include headache, weight changes, dry mouth, GI upset, flu like s/s, dizziness.

Serotonin and Norepinephrine reuptake inhibitors (SNRIs)

Decreases reuptake of norepinephrine and serotonin with similar side effects to SSRIs

Atypicals

Do not fit into other categories and is used to treat depression, psychotic disorder and anxiety disorder. Affects serotonin and dopamine and can experience weight gain, increased cholesterol, and diabetes

Tricyclics (TCA)

Block presynaptic reuptake of serotonin and norepinephrine, increases the effect at these receptors. Takes 2-4 weeks for effects.

Avoid if diagnosed with urinal retention or closed angle glaucoma and monitor for anticholinergic effects

Anticholinergic Effects

Get dry, slow, and confused so essentially you can’t pee, can’t see, can’t spit, can’t shit

Monoamine Oxidase Inhibitors (MAOIs)

Blocks MAOI enzymes, increases NE, dopamine, 5HT, and tyramine. Can take 2-4 weeks for effects to set in

Very restrictive diet with this, cannot have tyramine containing foods. And cannot take while pregnant

MAOIs and Tyramine

Can cause high BP, fainting, high HR, and orthostatic hypotension

Nardil (Phenelzine) and Parnate (Tranylcypromine)

type of MAOIs

Benzos and Barbituates

Treat anxiety and anxiety related to depression. Can experience hangover like effects and acts on the limbic, thalamic, and hypothalamic systems, causing relaxation effects.

Side effects can be drowsiness, sedation, and suicidal ideation if history of substance abuse. Avoid during pregnancy

Anticonvulsants (AED)

Used to treat withdrawal syndromes, anxiety, dementia, bipolar, and schizophrenia. Affects mood, CNS, and GABA

Valproic Acid (Depakote) and Carbamazepine (Tegretol)

Type of anticonvulsants

Lithium

Used to treat mania, bipolar, MDD, schizoaffective, schizophrenia, eating disorders, phobias, ADHD, and PTSD

Is a salt that alters NA transport to muscle and nerves cells. Must maintain balanced fluid and electrolyte balance

TSH, T3, T4 levels need to be checked as it can harm the thyroid

Antipsychotics/Neuroleptic Agents

Treat impaired thought process disorders by blocking dopamine receptors to help organize thoughts. Can take several weeks for effects to show and crosses the placenta and goes into breast milk

Dystonia

Type of EPS that consists of body posturing, tight jaw, and stiff neck from overactive acetylcholine

Pseudoparkinsonism

Type of EPS that consists of the S/S of parkinsons but don’t have it. Rigid and stiff

Akathisia

Type of EPS that includes restlessness, marching, jitters, and rocking

Tardive Dyskinesia (TD)

Type of EPS that must be caught early as it is permanent otherwise. Consists of irregular, repetitive involuntary movements

Abnormal Involuntary Movement Scale (AIMS) is used to recognize this.

Cause is unknown, may be due to neurotransmitter imbalance

Benztropine (Cogentin) and Trihexyphenidyl (Artane)

Types of Anticholinergics

Diphenhydramine (benadryl)

Type of antihistamine

Lorazepam (Ativan), Clonazepam (Klonopin), Diazepam (Valium)

Type of Benzos

Serotonin Syndrome

Toxic state caused by an increase in brain serotonin activity consisting of restlessness, myoclonus, tremor, rigidity, and hyperreflexia. Must stop meds if this occurs

Can be fatal due to cardiac collapse

Neuroleptic Malignant Syndrome

Potentially life threatening reaction to antipsychotic drugs that can happen after taking the drug for the first time or abrupt stoppage of drugs.

Presents with muscle rigidity, hyperthermia, vital sign instability, and elevated creatine kinase