ANTIDEPRESSANT AGENT
INTRODUCTION:-
Antidepressant are those drugs, which are used for the treatment of depressive illness.
These are also called as mood elevators or thymoleptics. Antidepressants are a class
of drugs that reduce symptoms of depressive disorders by correcting chemical
imbalances of neurotransmitters in the brain. Chemical imbalances may be
responsible for changes in mood and behaviour. Anti-depressants (SSRIs, MAOIs,
tricyclic antidepressants) have been found effective in treating anxiety.
CLINICAL SYMPTOMS OF DEPRESSION
• loss of pleasure (anhedonia)
• loss of energy
• social withdrawal psychomotor retardation or agitation
• insomnia
• loss of appetite
• decreased hygiene
• crying spells
• difficulty in concentrating
• indecisiveness
• sad thoughts/thoughts of suicide
• hopelessness
• helplessness
• guilt/shame
CLASSIFICATION:-
There are many different kinds of antidepressants, including:
Class example Trade names Oral dosages mg/dl
Tri-cyclic Imipramine Antidep 75-300
antidepressants
Clomipramine Anafranil 75-300
Selective serotonin Fluoxetine Fludac 10-80
reuptake inhibitors
Sertraline Serenata 50-200
(SSRIs)
Atypical Mirtazapine Remeron 100-400
antidepressant
Monoamine oxidase Trazadone Trazalon 150-600
inhibitors (MAOIs)
Isocarboxazid Marplan 10-30
INDICATION:-
Depression
Depressive episode
Dysthymia
Reactive depression
Abnormal grief reaction
Childhood psychiatric disorders
Panic attack
Agoraphobia, social phobia
OCD with or without depression
Eating disorder
Personality disorder
Medical disorders
Chronic pain
Migraine headache
Peptic ulcer disease.
CONTRAINDICATIONS
Antidepressant drugs
hypersensitivity.
myocardial infarction
angle-closure glaucoma.
hepatic,renal, or cardiac insufficiency
psychotic patient.
benign prostatic hypertrophy.
Seizures.
1. TRICYCLIC ANTIDEPRESSANTS
Mechanism of action:-
The exact mechanism is unknown. The predominant action is by increasing catecholamine
levels in the brain. TCAs are also called as Mono Amine Reuptake Inhibitors (MARIs). The
main mode of action is by blocking the reuptake of nor-epinephrine (NE) or serotonine (5HT)
at the nerve terminals, thus increasing the NE and 5HT levels at the receptor site. It takes
about 2-3 weeks for TCAs to bring down depressive symptoms.
Interactions
● Increased effects of tricyclic antidepressants with bupropion, cimetidine, haloperidol,
SSRIs, and valproic acid.
● Decreased effects of tricyclic antidepressants with carbamazepine, barbiturates, and
rifamycins.
● Hyperpyretic crisis, convulsions, and death can occur with MAO inhibitors.
● Co-administration with clonidine may produce hypertensive crisis.
● Potentiation of pressor response with direct-acting sympathomimetics.
● Increased serum levels of carbamazepines occur with concomitant use of tricyclics.
● Increased risk of seizures with concomitant use of maprotiline and phenothiazines.
Side effect with nurses role
a. Blurred vision
*Offer reassurance that this symptom should subside after a few weeks.
*Instruct the client not to drive until vision is clear.
b. Constipation
*Order foods high in fibre; increase fluid intake if not contraindicated; and encourage the
client to increase physical exercise, if possible.
[Link] retention
*Instruct the client to report hesitancy or inability to urinate.
*Monitor intake and output.
*Try various methods to stimulate urination, such as running water in the bathroom or
pouring water
over the perineal area.
d. Orthostatic hypotension
*Instruct the client to rise slowly from a lying or sitting position.
*Monitor blood pressure (lying and standing) frequently, and document and report significant
changes.
*Avoid long hot showers or tub baths.
e.. Tachycardia; arrhythmias
*Carefully monitor blood pressure and pulse rate and rhythm, and report any significant
change to
the physician.
f. Photosensitivity
*Ensure that client wears sunblock lotion, protective clothing, and sunglasses while outdoors.
g. Weight gain
*Provide instructions for reduced-calorie diet.
*Encourage increased level of activity, if appropriate.
MAOIs
Monoamine oxidase inhibitors (MAOIs) is instead act on monoamine oxidase ( MAO) which
is responsible for the degradation of catecholamines after re-uptake. The final effect is the
same , a functional increase in the NE and 5-HT levels at the receptor site. The increase in
brain amine levels is probably responsible for the antidepressant action. It takes about 5-10
days to bring down depressive symptoms.
Drug interaction
● Hypertension or hypotension, coma, convulsions, and death may occur with opioids (avoid
use of meperidine within 14 to 21 days of MAO inhibitor therapy).
● Excess CNS stimulation and hypertension may occur with methylphenidate.
● Additive hypotension may occur with anti-hypertensives, thiazide diuretics, or spinal
anesthesia.
● Additive hypoglycemia may occur with insulins or oral hypoglycemic agents.
● Consumption of foods or beverages with high caffeine content increases the risk of
hypertension and arrhythmias.
● Bradycardia may occur with concurrent use of MAOIs and beta blockers.
Side effect with nurses responsibility
a. Hypertensive crisis
discontinue drug immediately; monitor vital signs;
administer short acting antihypertensive medication, as ordered by physician;
b .hyper-pyrexia.
Provide well ventilated room.
Provide sponge bath.
Administer antipyretic drug.
c. Application site reactions -The most common reactions include rash, itching, erythema,
redness etc.
reported to the physician.
Topical corticosteroids have been used in treatment.
SSRIs
SSRIs block the reuptake of serotonin into the presynaptic nerve terminal, thereby
enhancing serotonin neurotransmission, which presumably results in their antidepressant
effects.
Drug interaction
Toxic, sometimes fatal, reactions have occurred with concomitant use of MAOIs.
● Increased effects of SSRIs with cimetidine, tryptophan, lithium.
● Serotonin syndrome may occur with concomitant use of SSRIs and metoclopramide.
● Decreased effects of SSRIs with concomitant use of carbamazepine and cyproheptadine.
Side effect with nurses role
a. Insomnia; agitation
*Administer or instruct client to take dose early in the day.
*Instruct client to avoid caffeinated food and drinks.
*Teach relaxation techniques to use before bedtime.
b. Headache
*Administer analgesics, as prescribed.
*Request that the physician order another SSRI or another class of antidepressants
c. Weight loss
*Ensure that client is provided with caloric intake sufficient to maintain desired weight.
*Weigh client daily or every other day, at the same time, and on the same scale, if possible.
d. Sexual dysfunction
*Men may report abnormal ejaculation or impotence.
*Women may experience delay or loss of orgasm.
ATYPICAL ANTIDEPRESSANTS:
mirtazapine are thought to work by increasing the amount of nor-epinephrine, serotonin, or
both in the central nervous system by blocking their reuptake by presynaptic neurons.
Drug interaction
● Concomitant use with MAOIs results in serious, sometimes fatal.
● Increased risk of liver injury with concomitant use of alcohol and duloxetine.
● Increased risk of toxicity when used concomitantly with duloxetine.
Side effect with nurses role
a. Dry mouth
*Offer the client sugarless candy, ice, frequent sips of water.
*Strict oral hygiene is very important.
b. Sedation
*Request an order from the physician for the drug to be given at bedtime.
*Request that the physician decrease the dosage or perhaps order a less sedating drug.
*Instruct the client not to drive or use dangerous equipment while experiencing sedation.
c. Nausea
*Medication may be taken with food to minimize GI distress.
OTHER NURSES RESPONSIBILITY FOR A PATIENT RECEIVING
ANTIDEPRESSANTS:-
Instruct the patient to take sips of water frequently to relieve dryness of mouth.
Frequent mouth washes, use of chewing gum, applying glycerine on the lips are also
helpful.
A high-fiber diet, increased fluid intake and laxatives if needed , help to reduce
constipation.
Observe the patient regularly for abnormal movements.
Advise the patient to use sunscreen measures (use of full sleeves, dark glasses etc) for
photosensitive reactions.
Instruct the patient not to take any medication without prescription.
Caution the patient to change his position slowly to minimize orthostatic hypotension.
Strict monitoring of vitals, especially blood pressure is essential.
PRACTICE TEACHING ON:-
ANTIDEPRESSANT AGENT
SUBMITTED TO:- SUBMITTED BY:-
[Link] BALA SAHU [Link]
ASSOC. PROFESSOR [Link]. (N) PREVIOUS YEAR
J.I.N.S.A.R. J.I.N.S.A.R.
SUBMITTED ON:-
MARCH 2015.
BIBLIOGRAPHY:-
R Sreevani : A Guide to Mental Health and Psychiatric Nursing, 3 rd edition,
Published by jaypee brothers, Page No. 114-115.
Dr.(Mrs). K. LALITHA: Mental Health And Psychiatric Nursing, Bangalore
Ganjanana book publisher, Page No. 193.
Lakhwinder kaur and Maninder kaur: A Text Book of Nursing Foundations,
Published by jaypee brothers, Page No. 181.
Mary C. Townsend: Psychiatric Mental Health Nursing, Concepts of care in
Evidence Based Practice, 6th edition, Published by Davis company F.A, Page No.
160-167.
[Link]. In.
