Depressive Disorders CH. 14 Flashcards
Selective serotonin reputable inhibitors SSRIs
Citalopram- Celexa
Selective serotonin reputable inhibitors SSRIs
Fluoxetine- Prozac
Selective serotonin reputable inhibitors SSRIs
Sertraline- Zoloft
Selective serotonin reputable inhibitors SSRIs
Education:
Advise on AE: Nausea, headache, CNS stimulation (agitation, insomnia, anxiety) rash
Sexual dysfunction can occur & notify HCP if effects are intolerable
Observe for manifestations of serotonin syndrome. If occur withhold medication and notify HCP
Avoid the concurrent use of St.John’s Wort it ⬆️ r/o serotonin syndrome
Follow a healthy diet, exercise regimen due to wt. gain can occur w/long term use
Tricyclic antidepressants
Amitriptyline- Elavil
Tricyclic antidepressants
Education:
Advise client to change positions slowly to minimize dizziness from Ortho.Hypotension, tachycardia
Minimize anticholinergic effects such as chew sugarless gum, eat foods w/ high fiber, ⬆️ fluid intake 2-3L/day from food & beverages
Constipation / urinary is emergent
Monoamine oxidase inhibitors MAOI
Phenelzine- Nardil
Monoamine oxidase inhibitors MAOI
Instruct the client to avoid all medications, including OTC w/o first discussing then w/ HCP due to r/o medication interactions
Atypical antidepressants
Bupropion- Wellbutrin
High dose increases seizures risk for insomnia, N&V, headache
Atypical antidepressants
Education:
Advise client to observe for headache, dry mouth, GI distress, constipation,⬆️ HR, nausea, restlessness,insomnia and notify HCP if they become intolerable
Monitor the client food intake & weight due to appetite suppression
Avoid administering to clients at risk for seizures
Serotonin norepinephrine reuptake inhibitors
Venlafaxine- Effexor XR
Serotonin norepinephrine reuptake inhibitors
Duloxetine- Cymbalta
Serotonin norepinephrine reuptake inhibitors
Education:
AE nausea, insomnia, wt.gain, diaphoresis, and sexual dysfunction
Caution ⚠️ in administrating to clients who have hx of HTN
SE: HTN, Tachycardia, Adrenergic effects, same as SSRIs
Alternative or Complementary therapies
ST. John’s wort: plant product (hypericum perforatum) not regulated by the US food and drug administration, is taken by some individuals to relieve manifestations of mild depression
Vivid dreams
AE: photosensitivity, skin rash, rapid HR, gastrointestinal distress, Abd.Pain
Can increase or reduce levels of some medications 💊 if take concurrently. The client should inform the HCP if taking St. John’s wart
‼️Med.Interactions: Potentially fatal ☠️ serotonin syndrome can result w/ St. John’s wart if taken w/ SSRIs or other types of antidepressants. Foods containing tyramine should be avoided ‼️
Selective Serotonin Reuptake Inhibitors- SSRIs
Escitalopram- Lexapro
Selective Serotonin Reuptake Inhibitors- SSRIs
Paroxetine- Paxil
Selective Serotonin Reuptake Inhibitors- SSRIs
Fluvoxamine-Luvox
Selective Serotonin Reuptake Inhibitors- SSRIs
Vilazodone-Viibyrd
Selective Serotonin Reuptake Inhibitors- SSRIs
Vortioxetine-Briitellix
Selective Serotonin Reuptake Inhibitors- SSRIs
MOA: all block the reuptake and the degradation (breaking down) of serotonin 5 HT
Psycho therapy for TX
Selective Serotonin Reuptake Inhibitors- SSRIs
7 S’s
-stomach upset mild nausea and bowel movements
-sexual dysfunction- anorgasmia delay, absence of organism
-sleep difficulties
-stress- aggravation, anxiety & tremors
-size increase- wt gain
-suicidal thoughts- 24yrs and ⬇️
-serotonin syndrome- fatal syndrome of having to much serotonin overstimulation. Rapid onset diarrhea,seizures, hyperthermia, muscle ridgity,coma ,death
Selective Serotonin Reuptake Inhibitors- SSRIs
1st line therapy for most types of depression
Low side effect profile compared w/older antidepressants.
Effective in depression/anxiety features as well as depression w/psychomotor agitation
Low lethality risk in suicide attempts
4-6 wk’s to take effect even 3-4 mo for Thera.levels
Give propranolol, blankets, dantrolene/diatezepam for muscle ridgity
Risk will happen when they combine with another med SSRI,MOAI, Try, SSNI only can take 1
2-5 wk’s can not manage there symptoms
Serotonin norepinephrine reuptake inhibitors
MOA: block the absorption or serotonin and norepinephrine in the brain
Tricyclic antidepressants
Amoxapine (only generic)
Tricyclic antidepressants
Desipramine- Norpramin
Tricyclic antidepressants
Doxepin-Sinequan
Tricyclic antidepressants
Imipramine- Tofranil
Tricyclic antidepressants
Maprotiline (generic only)
Tricyclic antidepressants
Nortriptyline-Pamelor
Tricyclic antidepressants
Protriptyline-Vivactil
Tricyclic antidepressants
Trimipramine-Surmontil
Tricyclic antidepressants
MOA: Inhibit the synaptic reuptake of serotonin and norepinephrine
Tricyclic antidepressants
SE:
Dry mouth
Blurred vision
Photophobia
Tachycardia
Constipation
Urinary retention & hesitancy
Hypotension
Sedation
Tricyclic antidepressants
-Must take therapeutic doses for TCAs for 10-14 days or longer before they begin to work
-Initial dose should always be low and ⬆️ gradually
Only good to take for 7 days the more days they take risk of toxicity
-considered risk in older adults, patients w/ cardiac ❤️dz.
-should have a thorough cardiac ❤️ workup before beginning TCA therapy
-Overdose carries a risk of death ☠️ from cardiac conduction abnormalities
-Cardiac toxicity, seizures, coma
Monoamine oxidase inhibitors MAOI
Isocarboxazid-Marplan
Monoamine oxidase inhibitors MAOI
Selegiline-Emsam transdermal patch ‼️ apply in a dry intact skin upper torso, thigh, outer surface of arm. At the same time of each day and switch sites. If patch falls off place another one asap and continue at its scheduled time
Avoid exposing to any form of heat
Monoamine oxidase inhibitors MAOI
Tranylcypromine-Parnate
Monoamine oxidase inhibitors MAOI
MOA: responsible for interacting or breaking down, monoamine neurotransmitter in the brain 🧠 such as norepinephrine, serotonin, dopamine & tyramine
Tyramine diet restrictions= hypertensive crisis occurs Stroke, death, coma, seizures, inter cranial hemorrhage take 15 mins after taking the tyramine food= Irritable, anxiety, flushing, sweating, severe headache= ER ASAP‼️ charcoal, fluid therapy, cooling blankets TX.
Monoamine oxidase inhibitors MAOI
SE:
Insomnia
Nausea
Agitation
Confusion
Orthostatic hypotension
Muscle twitching
Sedation
Monoamine oxidase inhibitors MAOI
Diet restrictions: HIGH Tyramine
-Aged cheese 🧀
-Red wine 🍷 and beer 🍺
-Smoked & processed meat 🥩
-Dried or cured fish 🐟
-Other food caviar, shrimp paste 🍤, soy sauce, sauerkraut
Monoamine oxidase inhibitors MAOI
Diet Restrictions: MODERATE Tyramine
-Gouda cheese
-Processed cheese 🧀
-Mozzarella
-Yogurt
-sour cream
-avocado 🥑
- bananas 🍌
-Colas
- Tea 🍵
- Chocolate 🍫
Monoamine oxidase inhibitors MAOI
Diet Restrictions: LOW Tyramine
-Pasteurized cheese 🧀 (cream cheese, cottage cheese)
-Ricotta
-Figs
-Distilled spirits
Atypical Antidepressants
Maprotiline
Atypical Antidepressants
Mirtazapine- Remeron
Atypical Antidepressants
Nefazodone
Atypical Antidepressants
Trazadone
Major Depressive Disorders
Patient needs to have 2 weeks of having sad moods and 4-5 symptoms will be a dx of MDD
Major Depressive Disorder
S/S of MDD: Fatigue or loss of energy
Hypersomnia/ sleep disturbances
Changes in appetite
Physo motor retardation
Feelings hopeless/worthless
Inability to think/concentrate
Changes in physical activity
Persistent thoughts/death & suicide
Major Depressive Disorders types
With or Without Psychotic features
Peripartum onset
Seasonal pattern
Peripartum Onset
Occurs a couple days after delivery a baby
4 weeks come after delivering the baby fatigue, appetite lost, sleep disturbances
Post Partum depression days after birth s/s similar to depressive disorder like psychotic, hallucinations, poor insight, poor judgment, loss of reality contact it is a medical emergency 🚨 danger to baby
Season pattern-MDD
Called winter depressive disorder due to less sun light ppl can develop seasonal disorder. When the spring and summer are here symptoms will disappear.
S/s are similar to depressive disorder just no suicide thoughts
TX: light therapy 1st line
Persistent Depressive Disorder aka dysthymia
Occur most of the day for a majority days. A mild form of depression. Early onset can start in childhood and adolescents.
Must have 3 clinical findings of depression
2yrs for adults
1yr for child/adolescent
Persistent Depressive Disorder aka dysthymia
Mild than MDD s/s
Changes of appetite
Fatigue
Premenstrual Dysphoric Disorder
Symptoms disappear after menstruating and start the week before menstruating
S/s markedly depressed mood
Excessive anxiety
Mood swings
Decreased interest in activities
Substance- induced depressive disorder
Substance is causing them to physiological depressive
Alcohol
Meth
Cocaine
Symptoms appear one month after using
Depression Assessment SIG E CAP
Sleep disturbances
Interest decreased in pleasure activities & sex
Guilty feelings
Energy decreased
Concentration
Appetite
Psychomotor function ⬇️
Suicidal Ideations
Assessment Tools to screen for depression
Beck Depression inventory
Hamilton Depression scale
Children’s depression rating scale CDRS
The geriatric depression scale
Atypical Antidepressants
Esketemine- Spravato nasal spray aka ketamine
Date rape drug not really prescribed
Only used for tx depression resistance so when nothing other meds work
Atypical Patient Education
Therapeutic effects may to be experienced for 1-3 wk’s. Full therapeutic effects may take 2-3 mo
-sudden discontinuation can result in relapse
-therapy usually continue 6 mo after resolution of manifestation and it may continue for 1yr or longer
-suicide prevention is facilitated by prescribing only a week worth of medication for an acutely I’ll client & inky prescribing 1 mo worth of med at a time especially w/ TCA which have a ⬆️ risk for lethality w/ overdose
-antidepressants induced suicide is mainly associated w/ clients under the age of 25
