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