Antidepressants Lecture Notes

Overview

• Focus on SSRIs, TCAs, and MAOIs.
• Commonly tested in nursing school and on NCLEX.
• Overarching theme: All antidepressants increase suicide risk.
  • Increased energy can lead to execution of suicidal plans.
  • Monitor patients for suicidal thoughts.
• Do not stop medications abruptly; taper off instead.

SSRIs (Selective Serotonin Reuptake Inhibitors)

• Uses: Depression, anxiety, OCD, eating disorders.
• Mode of Action: Inhibits reuptake of serotonin, increasing serotonin levels in the brain.
• Suffixes: talopram, oxidine, zodone (Exception: Seraltine).
• Side Effects:
  • Sexual dysfunction
  • Stomach issues (GI upset)
  • Weight gain (Swollen)
  • Serotonin syndrome: muscle rigidity, restlessness, high heart rate, blood pressure, mental changes
• Patient Education:
  • Takes 4-6 weeks to take effect; emphasize compliance.
  • Take in the morning ("Take at sunrise").
  • Avoid abrupt discontinuation.
  • Encourage healthy diet and exercise for weight management.
  • Do not combine with MAOIs or St. John's Wort (Risk of serotonin syndrome).

TCAs (Tricyclic Antidepressants)

• Uses: Depressive episodes, bipolar disorder, OCD, neuropathy.
• Mode of Action: Blocks reuptake of serotonin and norepinephrine.
• Suffixes: tryptaline, pramine (Exception: Amoxapine).
• Side Effects:
  • Dizziness, orthostatic hypotension
  • Anticholinergic effects: urinary retention, blurred vision, dry mouth, constipation
• Patient Education:
  • 14-day washout period after MAOIs before starting TCAs.
  • Rise slowly to prevent falls (orthostatic hypotension).
  • Increase fluids and fiber to combat dry mouth and constipation.

MAOIs (Monoamine Oxidase Inhibitors)

• Uses: Depression.
• Mode of Action: Inhibits monoamine oxidase, increasing epinephrine, norepinephrine, dopamine, and serotonin.
• Mnemonic: TIP (Trancroplamine, Isocarbonase, Phenoxyne).
• Patient Education:
  • 14-day washout period after MAOIs before starting SSRIs or TCAs.
  • Avoid tyramine-rich foods to prevent hypertensive crisis (e.g., aged cheese, fermented meats, overripe fruits).
  • Take in the morning to avoid sleep disturbances ("MAOIs in the morning").
  • Takes 4 weeks to reach therapeutic effect ("4 letters in MAOI").

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