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ANTIDEPRESSANTS1

Mia Thomas

All antidepressants function to increase the level of the specific neurotransmitters


to elevate the clients mood. The SSRI's are usually the first choice for treatment due
to their limited side effects. The TCA's MAOI's are reserved for the more severly
depressed clients. Some other uses for Anti-depressants especially the SSRI's are
many other emotional problems, such as anxiety disorders, eating disorders,
personality disorders, sleep disorders, phobias and for some medical conditions,
such as migraine headaches, chronic pain, peptic ulcer disease, and premenstrual
dysphoria.

General contraindications for all Anti-Depressants are caution in pregnancy,


elderly, use with clients with hepatic, renal, or cardiac insufficency. Most
antidepressants are metabolized in the liver and excreted via the renal
system. Caution use for clients with benign prostatic hypertrophy, Psychotic clients and in
children and young adults. Avoid alcohol. Instruct client that it their symptoms may lift in 4
weeks, but overall effectiveness will not be seen until 12 to 13 weeks.

SSRI's MAOI's

Block the reuptake of Inhibit the enzyme


serotonin in the synapse's monoamine oxidase from
therefore making more of destroying
the nuerotransmitter nuerotransmitters thus
available to elevate the increasing their
mood concentration in the
synapse
 All not combined with MAOI's

Celexa (citalopram) -Initial dose 20 mg


daily. May be increased to 40 mg daily
Nardil (phenelzine) 15 mg PO tid
after a minimum of 1 week. Maximum
May be increased rapidly to 60 mg
dose 40 mg daily. taken once a day, in
daily. Maximum dose 90 mg daily which
the morning or evening, with or without
can then generally be reduced to 15 mg
food.
daily. Have clients report any signs of a
Lexapro (escitalopram) 10 mg once daily hypertensive crisis: dizziness, headach
in morning or evening. May be Parnate (tranylcypromine) 10 mg PO
increased to 20 mg daily after a tid
minimum of one week. Drowsiness,  May be increased by 10 mg daily at 1 to
the CNS are established. It may cause 3 week intervals. Maximum dose 60 mg
sexual dysfunctions, such as ejaculation daily. This is a potent drug which is
disorder, impotence, anorgasmia, and capable of producing serious side
menstrual cramps. effects. Thhe most dangerous reaction
to Parnate is a surge in blood pressure,
Luvox (fluvoxamine) 50 mg at bedtime which has sometimes been fatal. For
May be increased in 50 mg increments this reason, you should tell clients to
every 4 to 7 days. Maximum dose 300 report promptly to their doctor any of
mg per day. the following symptoms: constriction or
pain in the throat or chest, dizziness,
Paxil (paroxetine) Initially 20 mg per day, fever, headache, irregular heartbeat,
usually in the morning. light sensitivity, nausea, neck stiffness
May be increased in 10 mg/day or soreness, palpitations, pupil dilation,
increments at intervals of at least one sweating, or vomiting.
week. May cause sexual dysfunction.

Prozac (fluoxetine) Initially 20 mg each


morning.
If no improvement is noted after 2
weeks, dosage may be increased to 80
mg per day in 2 divided doses. Tell
client to avoid taking drug in the early
afternoon. Commonly causes
nervousness and insomnia.

Zoloft (sertraline) Initial dose 50 mg


daily as a morning or evening dose.
May be increased by 50 mg daily at
weekly intervals.
Maximum dose: 200 mg daily.
Monitored for suicidal tendencies

TCA's SNRI's

Inhibit the reuptake of serotonin The SNRIs increase the levels of


and norepinephrine making them both serotonin and norepinephrine
more available at the synapse's. by inhibiting their reabsorption
 Most taken at night due to into the cells of the brain. The
sedation resultant higher levels of these
 Non-concurrent with MAOI hormones enhance
 Anti-cholinergic side effects neurotransmission - the sending of
nerve impulses - and thus improve
and elevate mood.
Anafranil (clomipramine) initially 25
mg PO daily with meals, gradually Cymbalta (duloxetine)  Initially 20 mg
increased to 100 mg daily in divided P.O. bid, then 60 mg P.O. once daily or
doses during the first 2 weeks. divided into two equal doses. Maximum
Maximum dose 250 mg daily in divided dose: 60 mg daily. Teach clients and
doses. After dosage is adjusted, daily family to observe for worsening of
dose is totally given at bedtime. depression, to consult physician if
taking any OTC's, swallow capsule
Sinequan (doxepin) Max dose300 mg whole.

Effexor (venlafaxine) 75 mg daily in 2 or


Elavil (amitriptyline) Initially 50 to
3 divided doses with food. May be
100 mg PO at bedtime. Parenterally: 20
increased in increments of 75 mg per
to 30 mg IM qid
day at no less than 4 day intervals.
Maximum dose: 300 mg daily. available
Maximum dose: Usually 225 mg daily.
in parenteral form
For severely depressed 375 mg per day.
Surmontil (trimipramine) Max Should be taken with food. Used with
dose300 mg caution in clients with high blood
pressure, glaucoma, heart, liver, or
Norpramin (desipramine) especially kidney disease, or in clients with
useful for depressed elderly clients who histories of seizure or mania.
are sensitive to anticholinergic effect
and for individuals with open-angle Prestique (desvenlafaxine) NEW !! With
glaucoma or prostatic hypertrophy. It is Prestiq, the starting dose is the
frequently prescribed for cardiac recommended dose. The recommended
clients. dose for Prestique is 50 mg once daily.
When stopping Pristiq, the patient's
Tofranil (imipramine) Max dose300 health care professional may gradually
mg reduce the dose. It should not be
Pamelor (nortriptyline) initially 25 stopped without first consulting with the
mg tid or qid gradually increasing to health care professional. Should be
150 mg daily. Entire dose may also be taken at the same time each day. It
given at bedtime. Serum levels should may be taken with or without food.
be monitored when dose is over 100 mg
daily.

Vivactil (protriptyline) The usual


adult dosage is 15 to 40 milligrams in 3
or 4 doses per day. The maximum
dosage is 60 milligrams daily. Increases
are made in the morning dos

Client care considerations:


Clients with an initial depressive episode may receive treatment for six months to a
year. However for clients with recurrent episodes, clients may require treatment for
up to 2 years. Special attention is given to the elderly, the chronically ill, the
debilitated, and the very young. Nurses play a major role in client assessment,
evaluation, monitoring, and teaching. Clients are different and medications and
doses may need to be adjusted several times to reach the desired effect. A
thorough drug histories should be performed to determine all other medications the
client is taking to minimize drug interactions. The nurse should be knowledgable
and watch for evidence of any adverse drug effects. Continual assessment of the
client's appearance, behavior, speech pattern, level of interest, and mood should be
monitored by the Nurse. In addition the client's eating, sleeping, elimination
patterns should be carefully assessed. Clients who are experiencing dizziness
should be help to ambulate if needed. Nurse also should monitor clients for
serotonin syndrome: those who may take too much medications and have impaired
hepatic and renal function are at risk. S/S of this syndrome are fever, dilated pupils,
hyperactive bowel sounds and diarrhea and/or presence or absence of diaphoresis.

Treatment of Serotonin Syndrome involves:


• Airway maintenance and oxygen therapy if needed
• Immediate treatment with activated charcoal in case of an overdose
• treatment of hypertension or hypotension
• Keeping the client safe while he/she is delirious and agitated
• Treatment for hyperthermia with benzodiazepines or aggressive cooling
• Stop all serotonergic medications immediately
• Administration of a serotonin antagonist, such as Cyproheptadine (Periactin)
1 All Sources taken from
http://www.edgt.com/EDGTOnline/tutorials/PsychdrugsV2/pdrugsopenframes.cfm

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