Antidepressants and Mood Stabilizers

Antidepressants and Mood Stabilizers Study Notes

Unit Overview

• Course: NUR 210/BSL 101

• Institution: Galen College of Nursing

• Unit: 3

Depression Etiology

• Genetic Predisposition: Inherited factors that increase risk for depression.

• Social and Environmental Factors: External influences that may trigger or exacerbate depressive episodes.

Pathophysiology Theories

• Decreased Levels of Monoamine Neurotransmitters: Key neurotransmitters involved in mood regulation include:

  • Norepinephrine

  • Serotonin

  • Dopamine

Types of Depression

• Reactive Depression: Triggered by external events or stressors.

• Major Depressive Disorder: Persistent and intense feelings of sadness.

• Bipolar Disorder: Characterized by extreme mood swings, including depressive and manic episodes.

Signs and Symptoms of Depression

• Emotional Symptoms: Depressed mood, feelings of despair.

• Physical Symptoms: Weight loss or gain.

• Interest: Loss of interest in normal activities.

• Energy Levels: Fatigue, insomnia or hypersomnia.

• Cognitive Function: Decreased ability to think or concentrate.

• Suicidal Thoughts: Increased risk of self-harm or suicidal ideation.

Complementary and Alternative Therapy for Depression

• Ginkgo Biloba and St. John’s Wort:

  • Mechanism: Can increase levels of serotonin, norepinephrine, and dopamine.

  • Precaution: Always consult a healthcare provider before taking herbal treatments.

Major Antidepressant Groups

• Selective Serotonin Reuptake Inhibitors (SSRIs):

  • Examples:

  • Sertraline (Zoloft)

  • Fluoxetine (Prozac)

  • Citalopram (Celexa)

  • Escitalopram (Lexapro)

  • Paroxetine (Paxil)

  • Fluvoxamine (Luvox)

• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):

  • Examples:

  • Duloxetine (Cymbalta)

  • Desvenlafaxine (Pristiq)

• Atypical Antidepressants:

  • Examples:

  • Mirtazapine (Remeron)

  • Bupropion (Wellbutrin)

• Tricyclic Antidepressants (TCAs):

  • Examples:

  • Amitriptyline (Elavil)

  • Desipramine (Norpramin)

  • Doxepin (Silenor)

  • Imipramine (Tofranil)

  • Nortriptyline (Pamelor)

• Monoamine Oxidase Inhibitors (MAOIs):

  • Examples:

  • Phenelzine (Nardil)

  • Selegiline (Emsam)

  • Tranylcypromine (Parnate)

• Serotonin Modulators:

  • Examples:

  • Trazodone (Desyrel)

  • Vilazodone (Viibryd)

  • Vortioxetine (Brintellix)

Selective Serotonin Reuptake Inhibitors (SSRIs) - Fluoxetine

• Action: Blocks the reuptake of serotonin, increasing its levels in the brain.

• Indications:

  • Major depression

  • Various anxiety disorders (e.g., OCD, panic disorder, phobias, PTSD)

  • Prevention of migraine headaches

  • Decrease premenstrual tension syndrome

  • Treatment of eating disorders

  • Substance use disorder

Advantages of Fluoxetine

• Fewer side effects of:

  • Sedation

  • Hypotension

  • Anticholinergic effects

  • Cardiotoxicity

Side Effects of Fluoxetine

• Headaches, nervousness.

• Blurred vision, insomnia.

• Dry mouth, gastrointestinal distress.

• Sexual dysfunction.

• Side effects may decrease over 1 to 4 weeks after initiation.

Adverse Reactions

• Suicidal ideation.

• Seizures.

• Hypoglycemia.

Contraindications

• Allergy to the medication.

• Concurrent use with MAOIs.

Cautions

• Breastfeeding.

• Current suicidal ideation.

• Liver/kidney disease.

• Glaucoma.

Drug Interactions

• Increased sedation with alcohol and other CNS depressants.

• Grapefruit juice intake may lead to toxicity - limit ingestion.

Grapefruit Juice and Drug Interactions

• Grapefruit juice may affect drug metabolism through enzyme and transporter interactions:

  • May cause increased drug levels, e.g., statins (leading to more side effects).

  • May cause decreased drug levels for other medications like fexofenadine (Allegra).

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) - Duloxetine

• Action: Inhibits the reuptake of both serotonin and norepinephrine.

• Indications:

  • Major depression.

  • Generalized anxiety disorder.

  • Social anxiety