Antidepressants Rx

• Side effects: Anticholinergic effects: dry mouth, blurred vision, tachycardia, postural hypotension, constipation and urinary retention, confusion (May go away with time), weight gain
• Action:  Unknown.  Increases the amount of norepinephrine or serotonin or both in the CNS by blocking their reuptake at the presynaptic neurons.  Inhibits more serotonin reuptake than norepinephrine.
• Nursing implications: 
• It can takes 2 weeks or longer to achieve full therapeutic effect.  Keep taking the medication. Sometimes takes up to 6-8 weeks for depression to lift.
• Should be monitored if takes 5-HT supplements and St. John’s Wart.
• Extremely dangerous for overdose because it is slowly excreted from the body . 

• Side effects: anxiety, insomnia, agitation, irritability, headache, yawning,  dry mouth, sweating, weight gain
• Nursing Implications: Monitor weight for weight gain
• Take it in the morning 
• Sleeplessness treated with Trazodone, 
• May take up to 3 weeks to establish a therapeutic blood level, teach clients to continue taking it.
• Stop taking SSRI for 5 weeks before introducing MAOI.
• Stop the MAOI 2 weeks before introducing SSRI.
• Consult drug information to check for drug interactions.
• SSRIs are on the Wal-Mart $4.00 list.
• Patients may need a change of antidepressant if there is no change in energy within 2 
• weeks of beginning antidepressant.
• Assess the patient for taking 5 HT supplements and St. John’s Wart.

• Serious side effects:  Serotonin syndrome
• Serotonin Syndrome: Restlessness, confusion, hallucinations, loss of coordination, fast heart beat, rapid changes in blood pressure, diaphoresis, shivering, tremor, ataxia, increased body temperature, overactive reflexes, myoclonus (twitching of the fibrils of a muscle), nausea, vomiting, and diarrhea.

• side effects: Effexor in doses over 225 mg/day may cause hypertension in some patients.
• Nursing implications: monitor BP

• Side effects: fewer sexual side effects than others.
• Nursing implications: It may take up to 4 weeks to get a therapeutic blood level.  
• Protect the drug from light.  
• Instruct patient to rise slowly from supine to sitting to standing.
• Avoid the use of alcohol since it may precipitate seizures.  
• At risk for seizures in doses over 400 mg.  Take the medication in scheduled doses thought out the day to prevent the risk of seizures, or take extended release form. 
• Causes less weight gain than other medications.
• Produces less sexual side effects than other medications.
• Avoid MAOIs.
• Avoid drinking alcohol while on medication.

• Least used.
• side effects: Anticholinergic effects, et al. 
• Nursing implications: concurrent administration of foods containing high concentrations of tyramine, ie anything with yeast or bacterial fermentation plus avocados and bananas. 

Side effects: Drowsiness, lightheadedness, dizziness, headache, blurred vision, sedation, nausea, interferes with stage 3 and 4 sleep, grogginess when waking, and vomiting.  Dose: 50-200 mg. daily at bedtime. Usual dose 100 mg.

• St. John's Wart
• Good for mild depression

• Improves nerve conduction.
• Studies have found a link between low levels of omega-3s and depression. (Salmon, cod, walnuts, flax, cod liver oil, mackerel).  If take omega-3 supplement need to supplement with good B-complex every day.