Hey there, it's Christine from Nurse in the Making. Today, we're gonna talk all things antidepressants. If you're following along in the Nursing School Complete Bundle, you can follow along in the Psychiatric Medications section.
This section looks like this, and it comes. and a nice chart of all the antidepressant medications. If you don't already have the complete nursing school bundle, you can find it in the description below.
So let's start by talking about antidepressants. So like I said, I'm gonna talk about the main anti- antidepressants. These are the main and most common ones tested in nursing school and on the NCLEX.
This is SSRIs, TCAs, and MAOIs. So there are some things to know for all antidepressants. Rather than memorizing them for each antidepressant, we're gonna memorize overarching theme. So all antidepressants increase the risk for suicide. Well, that seems kind of confusing and I remember being confused in nursing school about this also, so let me explain.
When you you start these medications they are going to increase your energy levels. So if a patient had a plan to commit suicide before this medication, after taking the medication they now have the energy to carry out this plan. So you as a nurse want to be monitoring for suicidal thoughts and suicidal comments made by the client. Things like I'm still depressed even though I have more energy. Those you want to be monitoring for.
So remember all antidepressants increase the risk for suicide. Another thing to remember is that you never want to stop these medications abruptly. You need to taper them and you need to educate your patient to not stop them abruptly as well. So let's get started.
The first one we're going to talk about is SSRIs. This is selective serotonin reuptake inhibitors. The uses are just like I said, depression, anxiety, OCD, and eating disorders.
The mode of action is in the name. I said it was a selective serotonin reuptake inhibitor. So basically it inhibits, it stops the uptake of serotonin in the brain. So which means if it stops the uptake of it, it stays in the brain.
So we have increased serotonin levels. I always remember the function of serotonin like smiley serotonin because this medication increases your mood. The great thing about SSRIs are there are suffixes to help you memorize these medications.
I like to call this saved by the suffix because these will save you on nursing exams and the NCLEX. These suffixes are talopram, oxidine, and zodone. There's only one outlier and this is seraltine, but you can think S for SSRIs, seraltine is an SSRI. So there are a few major side effects you should be familiar with when thinking of SSRIs. I remember it in nursing school, like the S's of SSRIs.
So we have sexual dysfunction, stomach issues, this is like GI upset, swole. because they cause weight gain and serotonin syndrome. This is one that you definitely want to be familiar with.
Serotonin syndrome is too much serotonin in the brain. Just like any medication which is meant for good, it ends up doing more harm because it's excreting its effect too much, right? There's a balance.
So serotonin syndrome is when you have too much serotonin in the brain. You should be familiar with the signs and symptoms of serotonin syndrome. This is muscle rigi...
restlessness, tightness in the muscles. They're gonna have a high heart rate, a high blood pressure, as well as mental changes. Okay let's look at some patient education points for you as a nurse to know to teach your patient while on this medication. The first one is that this medication may take up to four to six weeks to take effect.
So what does that mean? Compliance is really important. Two weeks in they might say the medication isn't working and you as a nurse needs to educate them.
them that, hey, it might take four to six weeks to take effect. Stick at it and keep taking the medication. For SSRIs, you want to take these medications in the morning. There's a really fun memory trick that I remembered in nursing school. SSRIs think take at sunrise.
So you want to take these in the morning. Just like I mentioned for all antidepressants, you never want to stop these medications abruptly. They need to be tapered.
To help combat that weight gain, you want to educate them to eat a healthy diet and exercise regularly. This next one is a huge NCLEX tip. So do not combine MAOIs or St. John warts with SSRIs because these cause too much serotonin levels in the brain.
And what did we say that was called? Serotonin syndrome. A fun memory trick to remember specifically for St. John warts is to think, St. John stay away from SSRIs because it's the worst to have too much serotonin in the brain. So St. John warts don't have with SSRIs. our eyes.
The next antidepressant The first antidepressants we're going to talk about is TCA's. These are tricyclic antidepressants. The uses are depressive episodes, bipolar disease, OCD, and also neuropathy. The mode of action is that it blocks the re-update of serotonin the same as SSRIs, but TCAs also block the reuptake of norepinephrine in the brain. So it blocks serotonin and norepinephrine uptake, which means there's more serotonin and norepinephrine in the brain.
Again, we're safe. by the suffixes with TCA's because tryptaline and pramine is the suffixes for these medications. Amoxapine is the only outlier so that one you just have to commit to memory. Some common side effects you'll see with TCA's are like dizziness, orthostatic hypotension, and those anti cholinergic effects. We know that this is can't pee, can't see, can't spit, and can't poop.
So we can't pee which means we have urinary retention. We can't see so we have blurred vision. We can't spit because we have a dry mouth and we can't poop because we have constipation. Okay, let's look at some patient education for TCAs.
You want to wait 14 days after being off MAOIs to start TCAs. Basically what that means is you want to have a washout period. You want to wash the body to make sure these medications aren't in the system at the same time. So that sweet number is 14 days.
Like I said before, these medications cause orthostatic hypotension. want to educate your patient to rise slowly when getting up or sitting up from the bed to prevent falls. I also said that TCA is kind of cause a dry mouth so some things to combat this is increasing fluids and sucking on sugar-free hard candies.
As for constipation to help combat this I like to remember this little memory trick. Fluids and fiber fill the toilet so you want to make sure to increase fluids and increase fiber in the patient's diet. Regular exercise and getting yourself moving also helps with constipation.
Next we have MAOIs. This is monoamine oxidase inhibitors. This is also used for depression.
The mode of action is in the name. It's a monoamine oxidase inhibitor which means it blocks monoamine oxidase which basically means that it increases epinephrine, norepinephrine, dopamine and serotonin in the brain which causes stimulation of the central nervous system. So unfortunately there aren't any suffixes to remember this medication. but I have a tip to remember these medications.
So the medications actually spell out tip. So I'm gonna attempt to pronounce these. So the T is for Trancroplamine, the I is for Isocarbonase, and the P is for Phenoxyne.
So it spells out tip. Now let's talk about patient education. Just like I said with the other antidepressant, you don't wanna take SSRIs or TCAs while being on MAOIs.
We need a washout period. What did I say that sweet number was? 14. So you want to wait 14 days after being off of MAOIs to start TCAs and SSRIs. So basically the point to memorize here is don't take SSRIs at the same exact time. A patient will never be on MAOIs and TCAs at the same time.
You need that washout period, 14 days. Something that's really important to remember for the NCLEX, they love to ask about this, is that you need to follow a tyramine restricted diet while being on MAOIs. MAOIs taken with tyramine foods can cause a hypertensive crisis, which we know can be lethal and is not a good thing. So let's talk about some foods that are high in tyramine. I like to remember these as the fermented foods.
So we have like aged cheese, fermented meats and livers, overripe fermented fruits, and we also have sour cream and yogurt. These are high in tyramine. So remember, stay away from tyramine foods when on MAOIs.
You want to educate your patients on the specific foods they need to avoid to avoid that hypertensive crisis. This medication should be taken in the morning because it can cause sleep disturbances. So we don't want to be taking it at night.
Just like SSRIs, I said think sunrise. We have a memory trick for MAOIs as well. MAOIs think morning.
We have the M and the M to remember that you want to take this medication in the morning. Just like a lot of the other antidepressants, they're going to take a few weeks to take effect. MAOIs take... take four weeks to reach therapeutic effect.
I remember this because MAOIs have four letters in it. M-A-O-I, takes four weeks to reach therapeutic levels. So just like I said, you wanna educate your patient on the importance of compliance. That's all for antidepressant medications.
If you want a nice chart of a layout of all the things we just talked about, you can grab the Complete Nursing School Bundle. The link is in the description below. If you want more pharmacology medication lessons and tips on how to get the most out of your medication, and tricks be sure to hit that subscribe button.
Thanks for watching and happy studying future nurses!