Antidepressants

Antidepressants


Action: Antidepressants are divided into the tricyclics, MAOIs, and miscellaneous antidepressants (SSRIs). The tricyclics work by blocking reuptake of norephinephrine and serotonin into nerve endings and increasing action of norephinephrine and serotonin in nerve cells. MAOIs act by increasing concentrations of endogenous epinephrine, norepinephrine, serotonin, dopamine in storage sites in CNS by inhibition of MAO; increased concentration reduces depression.

Uses: Antidepressants are used for depression and, in some cases, enuresis in children.

Side effects / Adverse reactions: The most serious adverse reactions are paralytic ileus, acute renal failure, hypertension, and hypertensive crisis, depending on the specific product. Common side effects are dizziness, drowsiness, diarrhea, dry mouth, urinary retention, and orthostatic hypotension.

Contraindications: The contraindications to antidepressants are convulsive disorders, prostatic hypertrophy, severe real, hepatic, cardiac disease depending on the type of medication.

Precautions: Antidepressants should be used cautiously in suicidal patients, severe depression, schizophrenia, hyperactivity, diabetes mellitus, pregnancy, and the elderly.

Interactions: Please check individual monographs since interactions vary widely among products.

Possible nursing diagnoses:
» Ineffective individual coping [uses]
» Risk for injury [uses/adverse reactions]
» Knowledge deficit [teaching]

Nursing Considerations


Assess:
» B/P (lying/standing), pulse q4h; if systolic B/P drops 20 mmHg, hold drug, notify prescriber; take VS q4h in patients with cardiovascular disease
» Blood studies: CBC, leukocytes, differential, cardiac enzymes if patient is receiving long-term therapy
» Hepatic studies: AST, ALT, bilirubin, creatinine
» Weight qwk, appetite may increase with drug
» EPS, primarily in elderly: rigidity, dystonia, akathisia
» Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms: depression, panic
» Urinary retention, constipation; constipation more likely to occur in children, elderly
» Withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness; do not usually occur unless drug was discontinued abruptly
» Alcohol consumption; if alcohol is consumed, hold dose until morning

Administer:
» Increased fluids if urinary retention occurs, bulk in diet, if constipation occurs
» With food or milk for GI symptoms
» Gum, hard candy, or frequent sips of water for dry mouth

Perform/Provide:
» Storage in tight container at room temperature; do not freeze
» Assistance with ambulation during beginning therapy, since drowsiness, dizziness occur
» Safety measures including side rails primarily in elderly
» Checking to see PO medication swallowed

Evaluate:
» Therapeutic response: decreased depression

Teach patient/famiy:
» That therapeutic effects may take 2-3 weeks
» To use caution in driving, other activities requiring alertness because of drowsiness, dizziness, blurred vision
» To avoid alcohol ingestion, other CNS depressants
» Not to discontinue medication quickly after long-term use; may cause nausea, headache, malaise
» To wear sunscreen or wide brimmed hat, since photosensitivity may occur

Selected Generic Names


Tetracyclics
Mirtazapine

Tricyclics
Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin
Imipramine
Nortriptyline
Timipramine

Miscellaneous
Bupropion
Nefazodone
Trazodone
Venlafaxine

MAOIs
Phenelzine
Tranylcypromine

SSRIs
Citalopram
Escitalopram
Flouxetine
Fluvoxamine
Paroxetine
Sertraline

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