Antidepressant

• Antidepressants aka Mood Elevators
• Antidepressants

  Indicated for depressive disorders
• Best time to take antidepressants: Morning with meals as it may cause insomnia
• Early indication of effectiveness of antidepressants: increased activity levels 
• Antidepressants are effective after 2 - 4 weeks , a follow-up visit is a must as increased energy at 2nd week from treatment may precipitate suicide
• Types of Antidepressants

  1. SSRI
  2. TCA
  3. MAOI
• Selective Serotonin Reuptake Inhibitor


  First line antidepressant; lesser SE
• SSRI 


  Indicated for all eating disorders and depression
• SSRI Examples:

  • Prozac
  • Celexa
  • Lexapro
  • Paxil
  • Zoloft
• Tricyclic Antidepressant 


  Second line antidepressant
• Tricyclic Antidepressant

  MOA: Nonselective inhibition of noreepinephrine and serotonin
• Tricyclic Antidepressant

  Examples: "Four sisters named Tofra, Ana, Ela, and Pamela are taking TCAs"
• Tricyclic Antidepressant

  Examples:

  • Tofranil
  • Anafranil
  • Elavil
  • Pamelor
• Tricyclic Antidepressant 


  Examples: Other mnemonic - SPENT
• Tricyclic Antidepressant

  Examples: Other mnemonic - SPENT

  • Sinequan
  • Pamelor
  • Elavil
  • Norpramine
  • Tofranil
• Antidote for TCA poisoning: Physostigmine (anticholinergic toxicity)
• Antidote for TCA poisoning: Physostigmine - antilirium
• Monoamine Oxidase Inhibitor 


  MOA: Inhibits neurotransmitter (serotonin) breakdown
• Monoamine Oxidase Inhibitor

  Examples: mnemonic - PAMANA
• Monoamine Oxidase Inhibitor

  Examples: mnemonic - PANAMA

  • Parnate
  • Marplan
  • Nardil
• Monoamine Oxidase Inhibitor

  Avoid Tyramine Rich foods = cause Hypertensive Crisis
• Monoamine Oxidase Inhibitor

  Avoid Tyramine Rich foods

  • Mature aged cheese or dishes made with cheese such as pizza and lasagna (except cottage, cream, ricotta, and processed cheese slices)
  • Aged meats such as salami, pepperoni
  • Fruits and veges: Banana, sauerkraut, kimchi, figs
  • Caffeine, cola, chocolate, tea
• Antidote for Hypertensive Crisis: Phentolamine (Regitine)
• SSRI: Nursing Management

  1. 14-day clearance before SSRI (avoid Serotonin Accumulation Syndrome)
  2. Taken in the morning
  3. Avoid giving meds with TCA or MAOI = FATAL
• When discontinuing antidepressants, the nurse should taper to avoid withdrawal symptoms