Anti-Depressant Pharm Therapy

SSRIs SE

sexual dysfunction

nervousness and agitation

nausea

weight gain

headache

dizziness

drowsiness

SSRI Drug Interactions

MAOIs: stop taking @ least 14 days before starting SSRI to reduce risk of serotonin syndrome

TCA: SS

Antihistamines: dry mouth, nausea

St. John’s Wort: SS

CNS: depressive effects

Dosing Admin

Take in morning to avoid nighttime drowsiness

Paroxetine Dosing

Must be taken with food

Pregnancy & Lactation considerations

Will cross placental barrier

Will cross into breast milk

Discuss with healthcare provider

Triicyclic Antidepressants

Amitriptyline

Impramine

Nortriptyline

Doxepin

ClompramineTr

Tricyclic Mech

Inhibit reuptake of both NOREPINEPHRINE + SEROTONIN

Anticholinergic action @ CNS

2 weeks to start working

4-8 weeks for max effect

TCA SE

Ortho hypo

Cardiac dysrhythmias

Tachycardia

Anticholinergic [dry mouth, blurred vision, urinary retention, decreased sweating]

TCA Drug Interactions

MAOIs

Oral contraceptives: can decrease effect of TCA

Antihistamines: increase anticholinergic effedcts

Antihypertensive meds: specific interactions with some agents

Antidysrhythmic drugs: potential for interaction due to cardiac effects of TCAs

TCA NC

Monitor LFTs

Monitor for suicidal ideation

Monitor for sexual side effects

Monitor weight gain

Obtain EKG, before starting to r/o pre-existing cardiac problems [esp > 40]

Take in morning

Rise slowly

No stopping abruptly

Chew sugar free gum/lozenges for dry mouth

Tetracyclic Antidepressants

Maprotiline

Mirtazapine

Tetracyclic Mech

Serotonin, norepinephrine, & histamine receptors: works on all of these

Tetracyclic Adverse Effects

Confusion

Agitation

Dizziness

Drowsiness

Dry mouth

Stomatitis [mouth inflammation]

Glossitis [tongue inflammation]

Tetracyclic Drug Interactions

CNS depressant: increased sedation

Antifungals: can increase adverse effects and riks of adverse reactions

MAOIs: risk of hyperpyrexia, hypertension, seizures, and serotonin syndormeT

Tetracyclic Nursing Considerations

Use cautiously in elderly patients due to decreased liver function

Akathisia: restlessness

Administer @ bedtime

NO MAOIs within 14 days

MAOIs Meds [TIP]

Isocarboxazid

Phenelzine

TranylcypromineM

MAOI Mech

Inhibit monoamine oxidase, an enzyme that breaks down/terminate action of neurotransmitters

Prevent enzyme from stopping action of neurotransmitters: dopamine, norepi, epi, and serotonin

Result: INCREASED NEUROTRANSMITTERS

NON-SPECIFIC

MAOI Timeline

4-8 weeks

MAOI SE

Ortho hypo

Insomnia

Headache

Diarreha

Dry mouth

Dizziness

Hypertensive crisis: when taken with another anti-depressant or foods containing tyramine

Interactions

Anti-depressants

Adrenergic drugs [epinpehrine, clonidine, albuterol]

OTC meds: antihistamines w/ decongestants

Insulin & oral antidiabetics: potential hypoglycemic effects

Opioids: CNS depression

MAOI Diet AVOID

Aged cheeses

Soy products

Tofu

Cured or processed meats

Salami

Pepperoni

Aged meats

Expired foods

Overripe foods

MAOI + DIETARY TYRAMINE

HYPERTENSIVE CRISIS

MAOI & Seizures

lowers seizure threshold

use cautiously w/ renal impairment

Atypical Antidepressants Meds

Bupropion

Nefazodone

Trazadone

Bupropion Mech

Inhibits uptake of dopamine & norepinephrine

Bupropion Function

Depression

Smoking Cessation

Nefazodone Mech

Blocks alpha receptors, works on serotonin reuptake

Trazodone Mech

Blocks alpha receptors, inhibits reuptake of serotonin

Atypical Antidepressants Adverse Effects

Aggression

Agitation

CNS Stimulation

Dizziness

Cardiac dysrhythmias

Hypertension

Hyper or hypo-glycemia

A. Antidepressant Drug Interactions

Levadopa: can increase adverse reactions

Antipsychotics & steroids: increased risk of seizures [esp. with nefazadone]

Digoxin & tamoxifen: decreases effectiveness

SNRIs Meds

Duloxetine

Venlafaxine

Desvenlafaxine

SNRIs Mech

Inhibit reabsorption of both serotonin and norepinephrine

SNRI Adverse Effects

Fatigue

Fever

Headache

Abnormal dreams

SNRI Interactions

MAOIs: hypertensive crisisSN

SNRIs & Pregnancy

Possible teratogenic effect —> Notify providerSe

Serotonin Syndrome S/S

Tachycardia

Hyper or hypotension

Hyperthermia

Diaphoresis

GI Distress

Confusion

Agitation

Anxiety

Disorientation

Serotonin Syndrome Neuromuscular Symptoms

Muscle rigidity

Spontaneous clonus [involuntary, rhythmic muscle contractions]

Muscle twitching