1 of 6
Affective Disorders vs Depression
o Affective disorder : A person’s mood goes far beyond the normal “ups and downs”
o Depression : Severe and long-lasting feelings of sadness beyond the precipitating event
Signs and Symptoms of Depression
o Low energy level
o Sleep disturbances
o Lack of appetite
o Limited libido
o Inability to perform activities of daily living
o Overwhelming feelings of sadness, despair, hopelessness, and disorganization
Biogenic Amine Theory of Depression
o Depression results from a deficiency of norepinephrine (NE), dopamine, or serotonin (5HT)
• Monoamine oxidase (MAO) may break them down to be recycled or restored in the neuron
• Rapid fire of neurons may lead to their depletion
• The number or sensitivity of postsynaptic receptors may increase, depleting neurotransmitter levels
Actions of Antidepressant Therapy
o Inhibits the effects of MAO, leading to increased NE or 5HT in the synaptic cleft
o Blocks reuptake by the releasing nerve, leading to increased neurotransmitter levels in the synaptic cleft
o Regulates receptor sites and breakdown of neurotransmitters, leading to an accumulation of neurotransmitters in
the synaptic cleft
Classifications of Antidepressants
o Tricyclic antidepressants (TCAs)
o Monoamine Oxidase inhibitors (MAOIs)
o Selective serotonin reuptake inhibitors (SSRIs)
o Atypical antidepressant (second generation)
Sites of Action for Selected Antidepressants
2 of 6
TRICYCLIC ANTIDEPRESSANTS
o Actions : Reduce the reuptake of 5HT and NE into nerves
o Use : All TCAs are similar, Choice depends on individual response to the drug and tolerance of adverse effects
o Indications
• Relief of symptoms of depression
• Used for patients with sleep disorders
• Treatment of enuresis
• Chronic pain
o Pharmacokinetics
• Absorbed from the GI tract
• Peak in 2 to 4 hours
3 of 6
• Bound to plasma proteins and lipid soluble
• Metabolized in the liver and excreted in the urine
• T½ 8 to 46 hours
o Contraindications : Known allergy, recent MI, myelography, pregnancy, and lactation
o Cautions : CV disease, angle closure glaucoma, urinary retention, and manic depression
o Adverse reactions : Sedation, sleep disturbances, fatigue, hallucinations, ataxia, dry mouth, constipation, nausea,
and vomiting
o Drug-to-drug interactions : MAOIs, cimetidine, fluoxetine, ranitidine, and oral anticoagulants
Monoamine Oxidase Inhibitors (MAOIs)
o Isocarboxazid (Marplan) : Used for patients who do not respond to or cannot take newer, safer antidepressants
o Phenelzine (Nardil) : Used for some patients who do not respond to newer, safer antidepressants
o Tranylcypromine (Parnate) : Used for adult outpatients with reactive depression
o Action : Irreversibly inhibit MAOs, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic
cleft
o Indication : Treatment of patients with depression who are unresponsive to or unable to take other antidepression
agents
o Pharmacokinetics
• Absorbed from the GI tract
• Peak in 2 to 3 hours
• Metabolized in the liver and excreted in the urine
• Cross placenta and enter breast milk
o Contraindications : Known allergy, pheochromocytoma, CV disease, headaches, and renal or hepatic impairment
o Adverse reactions : Dizziness, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia,
agitation, liver toxicity, nausea, vomiting, diarrhea or constipation, anorexia, weight gain, dry mouth, and abdominal
pain
o Drug-to-drug interactions
• Other antidepressants: hypertensive crisis and coma
• Methyldopa: sympathomimetic effects increase
• Insulin or oral antidiabetic agents: additive hypoglycemia
o Food interactions : Tyramine or pressor amines: increase blood pressure
Selective Serotonin Reuptake Inhibitors (SSRIs)
o The newest group of antidepressant drugs
o Specifically block the reuptake of 5HT, with little to no known effect on NE
o Do not have the many adverse effects associated with TCAs and MAOIs
o Action : Inhibit CNS neuronal reuptake of serotonin with little effect on norepinephrine and little affinity for
cholinergic, histaminic, or alpha-adrenergic sites
o Indications : Depression, OCD, panic attacks, bulimia, PMDD, posttraumatic stress disorders, social phobias, and
social anxiety disorders
o Pharmacokinetics
• Absorbed from the GI tract
• Metabolized in the liver
• Associated with congenital abnormalities
o Contraindications : Known allergy, pregnancy, lactation, and impaired renal or hepatic function
o Adverse reactions : Headache, drowsiness, dizziness, insomnia, anxiety, tremor, and agitation
o Drug-to-drug interactions
• MAOIs
• TCAs increase therapeutic and toxic effect
Atypical (Heterocyclic or Second Generation) Antidepressant
Miscellaneous Antidepressants
o Bupropion (Wellbutrin, Zyban)
o Mirtazapine (Remeron)
o Nefazodone (Serzone)
o Trazodone (Desyrel)
o Venlafaxine (Effexor)
4 of 6
MOOD STABILIZER - LITHIUM
Trade name : Eskalith, Lithane, Lithonate, Lithobid
Therapeutic action : treat bipolar manic depressive psychosis, manic episodes
o Alteration of ion transport in muscle and nerve cells; increase receptor sensitivity to serotonin.
o Alters sodium transport in nerve and muscle cells
o Inhibits the release of norepinephrine and dopamine—but not serotonin—from stimulated neurons
o Increases the intraneuronal stores of norepinephrine and dopamine slightly
o Decreases intraneuronal content of second messengers
Contraindications : Liver and renal disease, pregnancy, lactation, severe cardiovascular disease, severe dehydration, brain
tumor or damage , sodium depletion, children 12 years old and below.
Side effects : headache, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, vomiting diarrhea,
polyuria, hypotension abdominal pain, muscle weakness and restlessness
Use of Antidepressant Agents Across the Lifespan
Adverse reaction : urinary incontinence, clonic movements, stupor, azotemia, leucocytosis, nephrotoxicity
o Cardiac dysrhythmias, circulatory collapse
Nursing responsibilities
o Observe for signs and symptoms of depression: mood changes, insomnia, apathy, or lack of interest in activities
o Monitor vital signs : orthostatic hypotension is common
o Monitor for suicidal tendencies when marked depression Is present.
o Evaluate client’s urine output and body weight. Fluid volume deficit may occur as a result of polyuria.
o Observe client for fine and gross motor tremors and presence of slurred speech which are signs of adverse reaction
o Check client’s cardiac status. Loss of fluids and electrolytes may cause cardiac dysrhythmias
o Monitor for signs of lithium toxicity.
5 of 6
6 of 6
