Antidepressant Drugs

Question 1

Selective Serotonin-Reuptake Inhibitors (SSRIs)

Answer 1

1st line of therapy for most types of depression

Blocks reuptake of serotonin which increases the availability of serotonin in the synaptic cleft

· Less anticholinergic side effects (dry mouth, blurred vision, urinary retention)

· Common adverse effects include:
agitation, sleep disturbance, tremor, headache, sexual dysfunction. Autonomic reactions are dry mouth, sweating, weight change, mild nausea, and loose bowel movements.

Varcarolis, pg. 247 - patient and family teaching

· Celexa (citalopram), Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine)

Question 2

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Answer 2

Blocks the reuptake of serotonin & norepinephrine - therefore, more serotonin and norepinephrine in the synaptic cleft

• Popular next step strategy after trying SSRIs

** Adverse effects include:**
hypertension, nausea, insomnia dry mouth, sweating, agitation, headache, sexual dysfunction

• Monitor BP, especially with high doses & history of HTN

· Effexor (venlafaxine)

Question 3

Tricyclic Antidepressants (TCAs)

Answer 3

Inhibits reuptake of norepinephrine & serotonin from synaptic gap
Require 10 to 14 days or longer to start to work
Full effects may take 4 to 8 weeks

Common adverse effects include: anticholinergic effects such as dry mouth, blurred vision, tachycardia, orthostatic hypotension, constipation, urinary retention

• If possible, the patient should take the full dose at bedtime to reduce the experience of adverse effects during the day
• Varcarolis, pg. 248 - patient and family teaching
• Elavil (amitriptyline), Anafranil (clomipramine), Sinequan (doxepin), Tofranil (imipramine)

Question 4

Monoamine Oxidase Inhibitor (MAOIs)

Answer 4

Breaks down neurotransmitters including norepinephrine, serotonin, dopamine, and tyramine

· Avoid foods containing tyramine - could bring about a hypertensive crisis, possible stroke

Common adverse effects: include orthostatic hypotension, weight gain, edema, change in heart rate and rhythm, constipation, urinary hesitancy, sexual dysfunction, vertigo, hypomanic or manic behavior, insomnia, weakness, and fatigue

· Nardil (phenelzine), Parnate (tranylcypromine)

Question 5

Electroconvulsive Therapy (ECT)

Answer 5

• Treatment of choice for some patients with severe depression, with high potential for suicide or when there is poor response to antidepressant drugs.
• Also used for marked agitation and vegetative symptoms or catatonia
• Involves passing a brief electric current through the brain triggering a brief seizure.
• ECT seems to increase the activity of brain chemicals/neurotransmitters, leading to improvement in mood or reduction of psychotic symptoms.
• Usual course: 2 to 3 treatments per week to a total of 6 to 12 treatments
• Procedure requires informed consent
• Patient preparation is similar to preoperative preparation
• Patient is given an anesthetic and a muscle-paralyzing agent
• Electrodes are placed on one or both sides of the head

Post-treatment assessment - LOC, vital signs, PERRL, sensations, elimination, etc.

Potential side effects include confusion, disorientation, and memory loss. Memory loss is usually transient and improves after treatments are completed.