MEDICATIONS

• Antidepressants and mood elevators

  Drugs used to treat depressive disorders caused by emotional or environmental stressors, losses, drugs, disease states such as cerebral vascular accidents, or depression that cannot be related to an identifiable cause
• Antidepressants are a range of medications used in the treatment of depression and other mental health conditions, and are some of the most commonly prescribed medications around
• Types of antidepressants


  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin–norepinephrine reuptake inhibitors (SNRIs)
  • Atypical antidepressants
  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
• Antidepressant medications


  Designed to change chemicals (neurotransmitters) in the brain that affect mood and emotions
• Tricyclic antidepressants (TCAs)


  • Increase the level of the neurotransmitters serotonin or nor epinephrine in the space between the nerve endings
• Monoamine oxidase inhibitors (MAOIs)

  • Prevent the metabolism of neurotransmitters, but are used less frequently than the TCA"s because they are less effective, must be given for longer periods before they are beneficial, are more toxic, have a longer duration of action, and may cause adverse reactions if taken with tyramine-rich foods
• Selective serotonin reuptake inhibitors

  • They inhibit the 5-hydroxytryptamine (5-HT) system uptake of indoleamine (serotonin)
• Atypical antidepressants


  They do not readily fit into the familiar categories of other anti-depressant
• St. John's Wort (Hypericum perforatum)

  May relieve mild to moderate depression
• Tricyclic Antidepressants (TCAs)


  • Amitriptyline (Elavil)
  • Imipramine (Tofranil)
  • Desipramine (Norpramin)
  • Nortriptyline (Aventyl)
  • Trimipramine (Surmontil)
  • Clomipramine (Anafranil)
• Tricyclic Antidepressants (TCAs)


  • They are not often a first choice for treatment because they tend to have more side-effects than the newer drugs, however, when other drugs do not provide relief from severe depression, these drugs may help
• Symptoms of depression treated by TCAs

  • Insomnia
  • Decreased appetite
  • Decreased libido
  • Excessive fatigue
  • Indecisiveness
  • Difficulty thinking and concentrating
  • Somatic symptoms
  • Irritability
  • Feelings of worthlessness
• Effectiveness of TCAs


  Seen after few days of taking these medications
• Indications for TCAs


  • Chronic insomnia
  • ADHD
  • Panic disorder
  • Eating disorder
• TCAs


  Most preferred class drug for major depression based on cost
• Response time for TCAs

  • 1-3 weeks initial response
  • 6-10 weeks maximum response
• Examples of TCAs


  • Anafranil (clomipramine)
  • Asendin (amoxapine)
  • Elavil (amitriptyline)
  • Norpramin (desipramine)
  • Pamelor (nortriptyline)
  • Surmontil (trimipramine)
  • Tofranil (imipramine)
  • Vivactil (protriptyline)
• Contraindications for TCAs


  • Pregnant women
  • Breastfeeding mothers
  • Recovering from myocardial infarction
  • Severe liver and kidney diseases
• Conditions where TCAs should be used cautiously

  • Asthma
  • Urinary retention
  • Hyperthyroidism
  • Benign prostatic hypertrophy
  • Alcoholism
  • Epilepsy
  • Schizophrenia
  • Glaucoma
  • Cardiovascular disorders
• Side effects of TCAs

  • Dry mouth
  • Blurred vision
  • Tachycardia
  • Urinary retention
  • Constipation
• Client education for TCAs

  • Take the drugs as prescribed
  • Avoid taking over-the-counter cold remedies or other drugs without the knowledge of the physician
  • Inform other professionals who may treat the client such as the dentist or surgeon of the drug therapy
  • Report any side effects
  • Avoid excessive exercise and high temperatures because anticholinergic effects of these agents block perspiration
• Monoamine Oxidase Inhibitors (MAOIs)


  • They are well known for their multiple drug and food interactions because they inhibit the enzyme that breaks down amino acids tyramine and tryptophan
• Examples of MAOIs


  • Marplan (isocarboxazid)
  • Nardil (phenelzine)
  • Parnate (tranylcypromine sulfate)
• Foods to avoid when taking MAOIs

  • All cheeses except cream or cottage
  • Meats and fish: aged or cured like salami, bacon, tocino
  • Fruits and vegetables: broad bean pods, tofu, soybean extracts
• Drugs to avoid when taking MAOIs

  • Other antidepressants
  • Nasal and sinus decongestants
  • Allergy, hay fever and asthma remedies
  • Narcotics esp. meperidine (Demerol)
  • Epinephrine
  • Stimulants
  • Cocaine
  • Amphetamines
• Alcohol to avoid when taking MAOIs

  • Draft beer
• Foods and drugs to consume with caution when taking MAOIs

  • Cheeses: mozzarella, cottage, ricotta, cream, processed
  • Meat and fish: chicken liver, herring
  • Fruits and vegetables: raspberries, bananas, small amount only of avocado, spinach
  • Alcohol: wine
  • Others: vetsin, pizza, small amounts only of chocolate, caffeine, nuts, dairy products
  • Drugs: insulin, oral hypoglycemic agents, oral anticonvulsants, thiazide diuretics, anticholinergic agents, muscle relaxants
• Conditions that prohibit the use of MAOIs

  • Asthma
  • Cerebral vascular disease
  • Congestive heart failure
  • Hypertension
  • Impaired kidney function
  • Cardiac arrhythmia
  • Hyperthyroidism
  • Liver disease
  • Abnormal liver function tests
  • Severe headaches
  • Alcoholism
  • Glaucoma
  • Atonic colitis
  • Paranoid schizophrenia
  • Debilitated clients
  • Clients over age 60
  • Pregnancy
  • Children under age 16
• Frequent side effects of MAOIs

  • Abnormal heart rate
  • Orthostatic hypotension
  • Drowsiness or insomnia
  • Headache
  • Dizziness
  • Blurred vision
  • Vertigo
  • Constipation
  • Weakness
  • Dry mouth
  • Nausea, vomiting and loss of appetite
• Client education for MAOIs

  • Take the drug as prescribed. Avoid altering the dosage or discontinuing the use of the drug.
  • Avoid the ingestion of tyramine- containing foods.
  • Report any symptoms indicative of a hypertensive crisis.
  • Avoid over activity because these agents may suppress anginal pain, a warning of myocardial ischemia
  • Have vision checked periodically because optic toxicity may occur if therapy is given over an extended period.
• Selective Serotonin Reuptake Inhibitors (SSRIs)


  • This class of antidepressant has become popular because of safe and more advantageous effects.
  • Flexible dosing is an advantage because single dose can be given in the morning or at bedtime.
  • Well tolerated and less toxic
• Examples of SSRIs


  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
  • Citalopram (Celexa)
  • Escitalopram (Cipralex)
  • Sertraline (Zoloft)
• SSRIs


  Act on the neurotransmitter serotonin, a brain chemical which helps to regulate mood
• Common side effects of SSRIs

  • Nausea
  • Vomiting
  • Diarrhea
  • Weight gain
  • Dry mouth
  • Headaches
  • Anxiety
  • Sedation
  • Decrease in sexual desire and response
  • Jittery or restless feeling
  • Sleep difficulties, such as problems falling asleep, waking in the night, vivid dreams or nightmares
• SSRIs


  • Fewer side effects, fewer anticholinergic effects, do not cause hypotension and sedation
• SSRIs


  Used to treat OCD, effect is seen in 1-3 weeks
• Contraindications and side effects of SSRIs

  • Caution should be used when SSRIs are prescribed concurrently with anticoagulants.
  • The dosage of theophylline and alprazolam are reduced to avoid excessive plasma concentration of both drugs, diazepam, alcohol and tyrptophan should be avoided.
• Client education for SSRIs

  • Take the drugs as prescribed
  • Avoid altering the dosage of the medication
  • Report any unusual symptoms
  • Avoid the use of alcohol, tryptophan and diazepam
  • Inform the physician if taking an anticoagulant or theophylline
  • Avoid operating hazardous machinery if drowsiness occurs
  • Notify the physician if symptoms of depression worsen
  • Keep the medication out of the reach of children
  • Have their blood pressure and pulse monitored initially and after each dosage change to detect hypotension, hypertension and irregular heart rates
• Examples of SSRIs


  • Celexa (Citalopram)
  • Luvox (Fluvoxamine)
  • Paxil (Paroxetine)
  • Prozac (Fluoxetine)
  • Zoloft (Sertraline)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)

  • Act on the brain chemical norepinephrine as well as serotonin