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ANTIDEPRESSANTS

TCAs, MAOIs, SSRIs, and other antidepressants

TRICYCLIC ANTIDEPRESSANTS
o ACTION AND INDICATIONS
o Increase the amount of norepinephrine, serotonin, or both through inhibition of reuptake, thus normalizing the hyposensitive receptor site associated with depression o Indicated for:
o the relief of symptoms of depression (anxiety, sleep disturbances oEnuresis in children older than 6

oObsessive-compulsive disorder (Clomipramine) oChronic intractable pain (Investigational) oTCAs are, in addition, anticholinergic

o CONTRAINDICATIONS/ CAUTIONS

TRICYCLIC ANTIDEPRESSANTS

o Allergy o Recent MI o Myelography within the previous 24 hours or in the next 48 hours; concurrent use of an MAOI o Pregnancy and lactation o Cardiovascular disorders o Narrow angle glaucoma, urinary retention, prostate hypertrophy, GI or GU surgery o Psychosis; manic depressive state o History of seizures o Hepatic or renal disease

TRICYCLIC ANTIDEPRESSANTS
o ADVERSE EFFECTS
o CNS: Sedation, sleep disturbances, fatigue, hallucinations, disorientation, visual disturbances, difficulty in concentrating, weakness, ataxia, and tremors o GI anticholinergic effects: dry mouth, constipation, anorexia, increased salivation, cramps, and diarrhea o GU effects: urinary retention and hesitancy, loss of libido, changes in sexual functioning o CV effects: orthostatic hypotension, hypertension, arrhythimias, myocardial infarction, angina, palpitations, stroke o Withdrawal syndrome: nausea, headache, malaise, vertigo, and nightmares

TRICYCLIC ANTIDEPRESSANTS
o Nursing Responsibilities o Limit drug access if patient is suicidal o Maintain initial dosage for 4-8 weeks o Give parenteral forms only if oral forms are not feasible or available o Give the major portion of the dose at bedtime if drowsiness and aticholinergic effects are severe o Reduce dosage if minor side effects occur and gradually discontinue the drug if major or potentially life-threatening effects occur o Provide comfort measures o Provide patient teaching

TRICYCLIC ANTIDEPRESSANTS
o IMPORTANT DRUGS oAmitriptyline (generic) oClomipramine (Anafranil) oDesipramine (Norpramin) oDoxepin (Sinequan) oImipramine (Tofranil) oNortriptyline (Pamelor)

MONOAMINE OXIDASE INHIBITORS


o ACTION AND INDICATION oImpair inactivation of norepinephrine, serotonin, or both, thus prolonging their presence in CNS synapses and increasing their concentrations in the body oUsed in treating depression and bulimia

MONOAMINE OXIDASE INHIBITORS


o CONTRAINDICATIONS/ CAUTIONS o Allergy o Pheochromocytoma o CV disease o Abnormal CNS vessels or fefects; history of headaches o Hepatic or renal impairment o Myelography within the past 24 hours or in the next 48 hours o Psychiatric conditions o Seizure disorders or hyperthyroidism o Patients to undergo surgery o Pregnancy or lactation

MONOAMINE OXIDASE INHIBITORS


o ADVERSE REACTIONS
o Dizziness, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia, agitation, and blurred vision o Liver toxicity o GI effects: nausea, vomiting, diarrhea/ constipation, weight gain, dry mouth, abdominal pain o Urinary retention, dysuria, incontinence, changes in sexual function o CV effects: orthostatic hypotension, arrhythmias, palpitations, angina, hypertensive crisis (char. by occipital headache, palpitations, neck stiffness, n/v, sweatin, dilated pupils, photophobia, tachycardia, chest pain. May progress to intracranial bleeding and stroke

MONOAMINE OXIDASE INHIBITORS


o NURSING RESPONSIBILITIES o Limit drug access if patient is suicidal o Monitor the patient for 2-4 weeks to acertain onset of full therapeutic effect o Monitor blood pressure and orthostatic hypotension o Monitor LFTs o Discontinue the drug and monitor patient carefully at any complaint of severe headache

MONOAMINE OXIDASE INHIBITORS


o NURSING RESPONSIBILITIES oHave phentolamine or another adrenergic blocker on standby as treatment in case of hypertensive crisis oProvide comfort measures oProvide a diet that is low in tyramine-containing foods oProvide thorough patient teaching

MONOAMINE OXIDASE INHIBITORS


o IMPORTANT DRUGS oTranylcypromine (Parnate) oPhenelzine (Nardil) oIsocarboxazid (Marplan)

SELECTIVE SEROTONIN REUPTAKE INHIBITOR

o ACTION AND INDICATION oBlock the reuptake of serotonin into the presynaptic cells, thereby increasing serotonin levels at the synapse oUsed to treat generalized anxiety disorders, depression, obsessivecompulsive disorder, and bulimia nervosa.

SELECTIVE SEROTONIN REUPTAKE INHIBITOR

o CONTRAINDICATIONS/ CAUTIONS
o Allergy o Impaired renal or hepatic function o Diabetes

SELECTIVE SEROTONIN REUPTAKE INHIBITOR

o ADVERSE EFFECTS
o CNS effects: headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, and seizures o GI effects: n/v, diarrhea, dry mouth, anorexia, constipation, and changes in taste o GU effects: painful menstruation, cystitis, sexual dysfunction, urgency, and impotence o Respiratory changes: cough, dyspnea, URI, pharyngitis

IMPORTANT DRUGS
o Fluoxetine (Prozac) o Sertraline (Zoloft) o Citalopram (Celexa) o Escitalopram (Lexapro) o Paroxetine Hcl (Paxil) o Fluvoxamine (Luvox)

SELECTIVE SEROTONIN REUPTAKE INHIBITOR

o NURSING RESPONSIBILITIES
o Arrange for lower dosage in elderly patients and in those with renal or hepatic impairment o Monitor for up to 4 weeks to ascertain onset of full therapeutic effect o Suggest that patients use barrier contraceptives o Provide comfort measures o Provide thorough patient teaching

Other Antidepressants
o Bupropion (Wellbutrin)depression, smoking cessation o Mirtazapine (Remeron) o Nefazodone (generic) o Trazodone (Desyrel) o Venlafaxine (Effexor)

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