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Tricyclic antidepressants: Amitriptyline (Elavil)
- 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 .
Selective Serotonin Reuptake Inhibitors (SSRI)—Fluoxetine (Prozac)
- 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.
Serotonin/norepinephrine Reuptake Inhibitors (SNRI)— Venlataxine (Effexor)
- side effects: Effexor in doses over 225 mg/day may cause hypertension in some patients.
- Nursing implications: monitor BP
Norepinepherine and Dopamine reuptake Inhibitor (NDRI)—Bupropion (Wellbutrin)
- 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.
Monamine Oxidase Inhibitors Isocarboxazid (Marplan)
- 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.
Antidepressant used for sleep (Trazodone)
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.
What is nature's prozac?
- St. John's Wart
- Good for mild depression
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.