depression and mood stabilization Flashcards
what is depression
- mood disorder
- interferes with everyday life for several weeks or longer
- affects people of all ages
- women more than men
what feelings are associated with depression
- sadness
- loss
- anger
- frustration
describe the pathophysiology of depression
immune factors: increased CRF and activation of HPA axis
monoamine neurotransmitter dysfunction: deficiency of norepi and serotinin
neuroendocrine factors: downregulation (decreased sensitivity of cortisol receptors)
other factors: genetic and environmental factors
describe newer antidepressants
- SSRIs and SNRIs
- first line tx
- effective and safer
- 4-6weeks for full effect
describe older antidepressants
- TCA and MAOIs
- more adverse effects
- require more monitoring
- more cost effective
give and example of a tricyclic antidepressant
imipramine
describe the action of tricyclic antidepressants (imipramine)
blocks the reuptake of norepi and serotonin at the presynaptic nerve endings
what are tricyclic antidepressants (imipramine) used for
treatment of depression
also for bedwetting in adolescents
whats the PO onset for tricyclic antidepressants (imipramine)
2-6hrs
use caution in older adults and children
what are some adverse effects of tricyclic antidepressants (imipramine)
- sedation
- orthostatic hypotension
- cardiac dysrhythmias
black box warning: TCAs are more toxic in overdose then other antidepressants and suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents and young adults ages 18-24
whats a contraindication of tricyclic antidepressants (imipramine)
cardiac abnormalities and MI
describe administration of tricyclic antidepressants (imipramine)
- PO given at bedtime to reduce bedtime sedation
- start with small dose and increase slowly
- pre-post mood assessment
what are some nursing implications of tricyclic antidepressants (imipramine)
- do NOT give with MAOIs
- or with antidepressants, herbs, grapefruit juice, or alcohol
describe patient education for tricyclic antidepressants (imipramine)
- take only as prescribed
- take with a glass of water and food if GI upset occurs
- do not stop abruptly
- do not crush or chew pills
- avoid alcohol
give an example of an SSRI
fluoxetine
describe the action of SSRIs (fluoxetine)
blocks the reabsorption of serotonin in the brain
what are SSRIs (fluoxetine) used for
- treatment of depression
- anxiety, OCD
- bulimia
- PMDD
whats the PO onset of SSRIs (fluoxetine)
6-8hrs
use caution in older adults and children
what are some adverse effects of SSRIs (fluoxetine)
- GI symptoms
- CNS stimulation
- serotonin syndrome (symptoms vary from mild to severe and can cause death)
black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant
whats a contraindication of SSRIs (fluoxetine)
known sensitivity
describe administration of SSRIs (fluoxetine)
- PO daily with food
- sugar free gum or candy to counteract dry mouth
- pre/post mood assessment
what are some nursing implications for SSRIs (fluoxetine)
- do NOT give with MAOIs
- also dont give with antidepressants, herbs, grapefruit juice, and alcohol
describe patient education for SSRIs (fluoxetine)
- take only as prescribed
- take with a glass of wtaer and food if GI upset occurs
- do not stop abruptly
- do not crush or chew pills
- avoid alcohol
give an example of an SNRI
venlafaxine
describe the action of SNRIs (venlafaxine)
inhibits the neuronal uptake of serotonin as well as inhibits the uptake of norepi in the brain
what are SNRIs (venlafaxine) used for
treatment of depression
- GAD
- social phobia
- panic disorder
whats the onset of PO SNRIs (venlafaxine)
6-8hrs
use caution in older adults and children
what are some adverse effects of SNRIs (venlafaxine)
- GI symptoms
- CNS
- cardiovascular
- GU
black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant
whats a contrindication of SNRIs (venlafaxine)
known sensitivity
describe administration of SNRIs (venlafaxine)
- PO daily with food
- extended release should be taken in the morning and evening at approximately the same time
- if patients have difficulty swallowing extended release capsules can be opened and given in applesauce
- pre/post mood assessment
what are some nursing implications of SNRIs (venlafaxine)
- do NOT give with MAOIs
- alos dont give with antidepressants, hebrs, grapefruit juice, and alcohol
describe patient education for SNRIs (venlafaxine)
- take only as prescribed
- take with a glass of water and food if GI upset occurs
- do not stop abruptly
- avoid alcohol
give an example of an MAOI
phenelzine
describe the action of MAOIs (phenelzine)
increases epinephrine, norepinephrine, serotonin, and dopamine in the CNS
what are MAOIs (phenelzine) used for
treatment of depression as third line
whats the onset of PO MAOIs (phenelzine)
2-4hrs
more likely to cause hypertensive crisis
what are some adverse effects of MAOIs (phenelzine)
- hypertensive crisis - avoid tyramine containing food (aged meats, cheese, and beer)
black box warning: suicide is the leading cause of death in adolescents - increased risk of suicide in children, adolescents, and young adults ages 18-24 taking an antidepressant
whats a contraindication of MAOIs (phenelzine)
known sensitivity
describe administration of MAOIs (phenelzine)
- PO three times daily
- may need reminder system
- can be crushed
- pre/post mood assessment
what are some nursing implications for MAOIs (phenelzine)
- do NOT give with SSRIs
- also do not give with antidepressants, herbs, tyramine foods, and alcohol
describe patient education for MAOIs (phenelzine)
- take only as prescribed
- take with a glass of water and food if GI upset occurs
- do not stop abruptly
- avoid alcohol
why does antidepressant discontinuation syndrom occur
occurs due to sudden termination of most antidepressants
what are some symptoms of antidepressant discontinuation syndrom
flu like sx
- insomnia
- nausea
- balance
- sensory disurbances
- hyperarousal
the nurse is teaching the importance of proper diet to a aptient taking an MAOI for depression. which of the following food selections by the patient indicates further teaching is required?
- tossed salad
- salami and swiss cheese sammie
- hamburger and fries
- chicken salad and grapes
- salami and swiss cheese sammie
aged meats and cheese contain tyramine which should be avoided when taking a MAOI
give an example of an atypical antidepressant and describe it
bupropion
action: inhibits reuptake of norepi, serotonin, an dopamine
adverse effects: CNS and others
black box warning for serious neuropsyciatric reactions when administered for smoking cessation
name and describe a mood stabilizing agent
lithium
- effective in controlling mania in 65-80% of pts by treating and preventing manic episodes
- decreases frequency and intensity of manic cycles
- stimulates neuronal growth, reducing brain atrophy in people with long standing mood disorders
whats used to treat bipolar disorder
lithium carbonate
describe the action of lithium carbonate
affects synthesis, release, and reuptake of several neurotransmitters in the brain including, acetylcholin, dopamine, GABA, and norepi
what is lithium carbonate used for
drug of choice in tx of bipolar disorder
what are some adverse effects of lithium carbonate
- metallic taste
- hand tremors
- GI side effects
what are some contraindications/cautions for lithium carbonate
- known sensitivity
- pregnancy
whats a nursing implication for lithium carbonate
do NOT give with diuretics
describe patient education for lithium carbonate
- take only as prescribed
- keep scheduled visits for blood tests
- maintain a normal diet
- use effective birth control
- monitor for signs of toxicity
