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Module 9

The document discusses several topics related to depression and antidepressants: 1. It defines affective disorder and depression, and lists common signs and symptoms of depression. 2. It describes the biogenic amine theory of depression, which links depression to deficiencies in neurotransmitters like serotonin and dopamine. 3. It explains how different classes of antidepressants like SSRIs, TCAs, and MAOIs work to increase levels of neurotransmitters in the brain. 4. It provides information on specific antidepressant drugs, including their mechanisms of action, indications, and potential side effects. 5. It also covers the mood stabilizer lithium, used to treat bipolar disorder, and

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Yuki Xairah Tunay
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
17 views

Module 9

The document discusses several topics related to depression and antidepressants: 1. It defines affective disorder and depression, and lists common signs and symptoms of depression. 2. It describes the biogenic amine theory of depression, which links depression to deficiencies in neurotransmitters like serotonin and dopamine. 3. It explains how different classes of antidepressants like SSRIs, TCAs, and MAOIs work to increase levels of neurotransmitters in the brain. 4. It provides information on specific antidepressant drugs, including their mechanisms of action, indications, and potential side effects. 5. It also covers the mood stabilizer lithium, used to treat bipolar disorder, and

Uploaded by

Yuki Xairah Tunay
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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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

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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

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• 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)

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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.

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