Antidepressants

Question 1

Classifications of mood disorders and their diagnostic criteria?

Answer 1

• depressed mood (sad, empty and hopeless)
• diminished interest or pleasure in activities
• significant weight loss
• insomnia
• fatigue / loss of energy
• feelings of worthlessness

Question 2

Major factors that contribute to depression?

Answer 2

• genetics
• biomedical factors
• illness
• personality style
• ageing
• long term pressures (abusive relationships, bulling, and work)
• stress and traumatic events

Question 3

What are the antidepressants?

Answer 3

• SSRI - selective serotonin reputable inhibitors
• SNRIs - serotonin noradrenaline reputable inhibitors
• TCSs - tricyclic antidepressants
• MAOIs - monoamine oxidase inhibitors

Question 4

What are the considerations for switching between antidepressant medications?

Answer 4

• withdrawal effects - N/V, nightmares, panic, restlessness, electric shock like sensations, anxiety, diarrhoea, tremor, agitation
• taper down slowly to avoid withdrawal effects
• may have to wait 14 days after finishing one antidepressant before starting the new one

Question 5

MOA and example of SSIR

Answer 5

= selective inhibit presynaptic reuptake of serotonin

e.g. citalopram and fluvoxamine

Question 6

Adverse reactions of SSIRs

Answer 6

• N&V
• agitation
• sexual dysfunction
• tachycardia
• increase liver enzymes

Question 7

Contradictions of SSIRs

Answer 7

• bipolar disorder

- high risk of bleeding

Question 8

Interactions of SSIRs

Answer 8

• other antidepressants

Question 9

Nursing practice points of SSIRs

Answer 9

• alter ability to drive and operate machinery
• stop treatment over several weeks
• monitor suicide thoughts
• first line

Question 10

MOA and examples of SNRIs

Answer 10

= inhibit serotonin and noradrenaline uptake

e. g. duloxetine
- venlafaxine

Question 11

Adverse reactions of SNRIs

Answer 11

• Nausea, dry mouth
• increase BP
• orthostatic hypotension/ fainting
• seizures
• cardiomyopathy

Question 12

Nursing practice points of SNRIs

Answer 12

• check BP before and after starting
• therapeutic response delayed by 2 weeks
• increased suicidal thoughts
• start small dose

Question 13

MOA and example of TCAs

Answer 13

= inhibit reuptake of noradrenaline and serotonin

• clopipramine
• amitripytine

Question 14

adverse reactions of TCAs

Answer 14

• anticholinergic effects
• sedation
• dry mouth
• blurred vision
• urinary retention
• postural hypotension
• slows cardiac conduction

Question 15

MOA and example of MADIs

Answer 15

= inhibit MOA-B increasing synaptic concentrations of adrenaline and noradrenaline

e.g phenelzine