Module 3: Depressive Disorders & Antidepressants Flashcards
How are antidepressants chosen?
Chosen based on:
- Symptoms
- Safety
- Adverse effect profiles
How long do most antidepressants take to have an effect?
2-8 weeks (never meant as PRN)
How should antidepressants be discontinued?
- Slow tapering necessary to avoid discontinuation syndrome
- Do not discontinue abruptly
What life-threatening condition can result from taking antidepressants?
Serotonin syndrome from overactivity of serotonin or an impairment of the serotonin metabolism
Ideal treatment for patients with severe or recurrent MDD (Major Depressive Disorder)?
psychotherapy + pharmacotherapy
Antidepressants have a high risk of doing what to patients with bipolar disorder?
Inducing mania
What is a concern with most antidepressants (even MAOIs)?
Orthostatic hypotension
Antidepressants black box warning?
Increased risk of suicidal thoughts and behaviors in patients aged 24 and younger.
Primary nursing assessment for depressive disorders?
- SAFETY!
- Assess presence of suicidal ideation
Define anhedonia.
The inability to experience joy or pleasure. You may feel numb or less interested in things that you once enjoyed
Biological nursing assessment for depressive disorders?
- History and Physical
- Substance and Medication Use
- Behaviors impacted by MDD:
- Nutrition, sleep, energy etc.
Psychosocial nursing assessment for depressive disorders?
- Mood and affect
- Thought content
- Cognition and memory
- Social Support
- Stress and Coping
- Components of MSE
Nursing interventions in the Psychosocial Domain?
- Establishing recovery and wellness goals
- CBT (Cognitive Behavioral Therapy)
- Thought stopping and positive self talk
- Support groups
- Patient and family teaching
Nursing interventions associated with Psychotherapeutic Management?
Nurse patient relationship :
- Accept patients as they are
- Assist in focusing on their strengths
- Validate their feelings
- Establish trust
- Point out small visible accomplishments and strengths
- Don’t attempt to manipulate patients from feeling depressed
- Don’t argue with a patient over hallucinations delusions or negative beliefs
- Spend time with patients to manage their social isolation
- Provide decision making opportunities for patients that can manage
Nursing interventions for Pharmacotherapy?
Monitor efficacy, side effects, and interactions
What are some additional therapies for depressive disorders?
- Electroconvulsive Therapy (ECT)
- Ventilate the patient, monitor vital signs, help with reorientation to a person, place, time
- Benzodiazepine PRN for agitation
Nursing intervention for Bright Light Therapy?
- Familiar with the adverse side effects (nausea, eye irritation)
- Contraindications include glaucoma, cataracts and the use of photosynthesizing medications
What does norepinephrine help with?
- Stress response
- Flight or fight
- Circadian rhythms
- Energy
- Arousal
What does dopamine help with?
- Pleasure
- Reward
- Attention
- Reinforcement
What does serotonin help with?
- Appetite
- Social rank
- Well-being
- Sleep
What are the classifications of antidepressants?
- Selective serotonin reuptake inhibitors (SSRls)
- Selective serotonin-norepinephrine reuptake inhibitors (SNRls)
- Norepinephrine dopamine reuptake inhibitors (NDRls)
- Monoamine Oxidase Inhibitors (MAOls)
- Serotonin-2 antagonist/serotonin reuptake inhibitor (SARI)
- Tricyclic antidepressants (TCA) are nonselective
List examples of SSRIs.
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
SSRI mnemonics?
Sexual Dysfunction
Serotonin syndrome
Stomach upset
Size increase (weight gain)
Restlessness
Insomnia
Suicidal ideation
Sodium loss
SSRIs risks?
- Bleeding risk
- Careful with NSAIDS, anticoagulants
List examples of SNRIs.
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
SNRIs adverse effects and considerations?
- Similar to SSRIs
- Monitor for hypertension (they can still have postural hypotension!)
List an example of NDRIs.
Bupropion (Wellbutrin, Zyban)
NDRIs nursing considerations?
- Less sedating than SSRI/SNRIs
- Fewer sexual side effects
List examples of TCAs.
- Amitriptyline (Elavil)
- Nortriptyline (Aventyl, Pamelor)
TCAs risk?
As effective as SSRIs but with more serious side effects and a higher lethal potential of CARDIAC TOXICITY
TCAs Mnemonic?
T - think
- Think how the drug works: Increase serotonin and norepinephrine
C - Cardiac
- Watch out for the heart: Orthostatic hypotension/dizziness
A - Anti- A lot
- Antidepressant (suicidal Ideation)
- Anticholinergic (delirium, seizures)
- Antihistamine (sleepiness, weight gain)
List examples of MAOIs.
- Phenelzine (Nardil)
- Selegiline (Emsam)
MAOIs nursing considerations?
- Wash out period: There must be a 2-week (14 day) wash out!
- This washout period is BOTH directions
- Patients should be closely monitored and educated about hypertensive crisis (avoid tyramine)
What to avoid during hypertensive crisis?
- Anything high in tyramine
- Sympathomimetic agents (adrenergic)
What foods are high in tyramine?
- Cheese
- Alcohol- Beer and Wine
- Cured/Aged/smoked meats (salami, pepperoni, fish, etc.)
- Fermented foods (sauerkraut, kimchi)
- Fava beans
- Avocado
- Caffeine!!
Which antidepressants are at risk for Serotonin Syndrome?
- SSRIs
- SNRIs
- MAOIs
Serotonin Syndrome S/S?
- Shivering
- Hyperreflexia
- Increased temperature
- Vital sign abnormalities
- Encephalopathy
- Restlessness
- Sweating
Serotonin Syndrome nursing interventions?
- Stop the serotonergic agent
- Cool and hydrate the patient
- May require hospitalization
- May administer cyproheptadine (an antihistamine with some anti-serotonergic action)
- Sedation with benzodiazepines
- Monitor vital signs
