Antidepressants Rx

  1. Tricyclic antidepressants: Amitriptyline (Elavil)
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    • 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 . 
  2. Selective Serotonin Reuptake Inhibitors (SSRI)—Fluoxetine (Prozac)
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    • 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.
  3. Paxil/paroxetine
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    • 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.
  4. Serotonin/norepinephrine Reuptake Inhibitors (SNRI)— Venlataxine (Effexor)
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    • side effects: Effexor in doses over 225 mg/day may cause hypertension in some patients.
    • Nursing implications: monitor BP
  5. Norepinepherine and Dopamine reuptake Inhibitor (NDRI)—Bupropion (Wellbutrin)
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    • 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.
  6. Monamine Oxidase Inhibitors Isocarboxazid (Marplan)
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    • 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. 
  7. Antidepressant used for sleep (Trazodone)
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    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.
  8. What is nature's prozac?
    • St. John's Wart
    • Good for mild depression
  9. What's good about omega-3 fatty acids as related to mood disorders?
    • 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.
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Antidepressants Rx
Mental health