ANTIDEPRESSANT DRUGS, types, side effects,nurses responsibility , SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)

 

2. ANTIDEPRESSANT DRUGS

 

An antidepressant drug is a psychiatric medication used to alleviate mood disorders, Such as major depression and dysthymia. These medication are among those most commonly prescribed by psychiatrist.

 

TYPES OF ANTIDEPRESSANT DRUGS

 

1.      SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)

 

Selective serotonin reuptake inhibitors (SSRIs) are a family of antidepressant drugs and considered as current standard of drug treatment. A possible cause of depression is an inadequate amount of serotonin, a chemical used in the brain t transmit signals between neurons. This family of drugs includes citalopram (Celexa), Fluoxetine (Prozac), & sertraline (Zoloft).

 

MECHANISM OF ACTION

 

            SSRIs are said to work by preventing the reuptake of serotonin (also known as 5 hydroxytryptamine, or 5-HT) by the presynaptic neuron, thus maintaining higher level of 5-HT in the synapse.

 

SIDE EFFECTS OF SSRIS

·         Nausea

·         Diarrhea

·         Agitation

·         Headaches

·         Suicidal tendencies

·         Drowsiness

·         Dry mouth

·         Nervousness

·         Anxiety

·         Insomnia

·         Decreased appetite

·         Sexual side effect such as loss of libido, failure to reach orgasm, erectile dysfunction, decreased ability of function sexually etc.

 

NURSING RESPONSIBILITY

 

·         Teach the patient the proper use of medication and explain the adverse effects.

·         Encourage the patient to increase fluid intake to avoid dry mouth.

·         Asses the patient’s suicidal potential.

·         Observe the patient for increased psychomotor activity.

·         Have Black Box warning to prevent suicidal incidences.

·         Provide small and frequent diet.

·         Maintain intake and output chart.

 

 

 

2.      TRICYCLIC ANTIDEPRESSANT DRUGS (TCA’S)

 

Tricyclic antidepressants are the oldest class of antidepressant drugs. They are used less commonly now due to the development of more selective and safer drugs. These drugs are often lethal in overdoses, as they may cause a fatal arrhythmia. However, tricyclic antidepressants are still used because of their effectiveness, especially in severe cases of major depression. These include:

 

·         Secondary Amine Tricyclic Antidepressants: It includes Desipramine (Norpramin), Nortriptyline (Aventyl).

·         Tertiary Amine Tricyclic Antidepressants: These include Amitriptyline (Elavil), Clomipramine (Anafranil), Imipramine (Tofranil).

·         Mechanism of action: Tricylics block the reuptake of certain neurotransmitters such as nor-epinephrine (nor-adrenaline) and serotonin.

 

SIDE EFFECT OF TCA’S

 

·         Drowsiness

·         Tremors

·         Sexual problems

·         Skin rash

·         Weight gain or loss

·         Increased heart rate

·         Drowsiness

·         Dry mouth

·         Constipation

·         Urinary retention

·         Blurred vision

·         Dizziness

·         Confusion

·         Sexual dysfunction

 

CONTRA INDICATIONS

 

1.      Excessive use of alcohol  or sedatives

2.      History of suicide or seizure episode

3.      Urine retention

4.      Acute angle closure glaucoma

5.      Hypersensitivity to the drugs

6.      Cardiovascular

 

NURSING RESPONSIBILITY

 

·         Teach the patient the proper use of medication and explain the adverse effects.

·         Instruct the patient to take medicine at night time to avoid day time drowsiness and dizziness.

·         Observe the patient for increased psychomotor activity

·         Asses the patient suicidal potential

·         Instruct the patient to report urine retention

·         Encourage the patient to increase fluid intake to avoid dry mouth.

·         Be aware that TCA’s should be avoided during first trimester of pregnancy and that they are extracted in breast milk.

 

3.      MONOMINE OXIDASE INHIBITOR (MAOIS)

 

Monoamine Oxidase inhibitors (MAOIs) may be used if other antidepressant medication are ineffective. Because there are potentially fatal interactions between this class of medication and certain food (particularly those containing tyramine) such as red win, as well as certain drugs.

 

MECHANISM OF ACTION

 

            MAOIs work by blocking the enzyme monoamine oxidase which breaks down the neurotransmitters dopamine, serotonin, and nor-epinephrine (nor-adrenaline).

 

SIDE EFFECTS

 

·         Difficulty in tolerating

·         Hepatitis

·         Heart attack

·         Stroke

·         Seizures

·         Serotonin syndrome

 

CONTRA INDICATION

 

1.      Kidney or liver disease

2.      Hypertension

3.      Cardiac arrhythmias

4.      Epilepsy

5.      Parkinsonism

 

NURSING RESPONSIBILITY

 

·         Teach the patient the proper use of prescribed medication and explain their adverse effects .

·         Advise the patient to take these medications early in the day to avoid insomnia.

·         Caution the patient to avoid over-the –counter drugs.

·         Instruct the patient to avoid the food containing Tyramine such as aged cheese, meat extracts, pickled hearing, sour cream and yogurt, soy sauce, chocolate dry fruits, red wine, snails, fermented foods especially with MAOI inhibitors.

·         Educate the patient about possible hypotension, demonstrate how to rise slowly from a chair or bed.

·         Urge the patient to report unexpected symptoms such as headache and increased palpaitations.

Home care :

·         Teach the patient the proper use of medications and explain the adverse effects.

·         Caution the patient to avoid over-the –counter drugs.

·         Instruct the patient to avoid the food containing Tyramine such as aged cheese, meat extracts, pickled hearing, sour cream and yogurt, soy sauce, chocolate dry fruits, red wine, snails, fermented foods especially with MAOI inhibitors.

·         Observe the patient for increased psychomotor activity.

·         Ask family members to keep a watch for patient’s suicidal potentials.

·         Be aware that TCA’S should be avoided during first trimester of pregnancy and that they are extracted in breast milk .

·         Encourage the patient to increase fluid intake to avoid dry mouth.

·         Take more fluids.

·         Insist use of fiber rich diet to prevent constipation.