Overview
This lecture covers key concepts, uses, side effects, and patient education points for three main classes of antidepressants: SSRIs, TCAs, and MAOIs, with a focus on nursing considerations and exam tips.
General Antidepressant Considerations
- All antidepressants increase the risk for suicide, especially when starting therapy, due to increased energy.
- Monitor patients for suicidal thoughts, especially if energy has improved but mood has not.
- Never stop antidepressants abruptly; always taper off to avoid withdrawal symptoms.
- Patient education on compliance is critical, as effects may take several weeks.
SSRIs (Selective Serotonin Reuptake Inhibitors)
- Used for depression, anxiety, OCD, and eating disorders.
- Inhibit serotonin reuptake, increasing serotonin levels and improving mood.
- Common suffixes include -talopram, -oxetine, -zodone; exception: sertraline.
- Side effects: sexual dysfunction, GI upset, weight gain, and serotonin syndrome.
- Serotonin syndrome symptoms include muscle rigidity, restlessness, high heart rate, high blood pressure, and mental changes.
- Patient education: may take 4-6 weeks for effect, take in the morning ("sunrise"), maintain healthy lifestyle, avoid abrupt stoppage.
- Do not combine with MAOIs or St. John's wort to prevent serotonin syndrome.
TCAs (Tricyclic Antidepressants)
- Used for depressive episodes, bipolar disorder, OCD, and neuropathy.
- Block reuptake of both serotonin and norepinephrine.
- Suffixes include -triptyline, -pramine; exception: doxepin.
- Side effects: dizziness, orthostatic hypotension, anticholinergic effects (urinary retention, blurred vision, dry mouth, constipation).
- Patient education: wait 14 days after MAOI use before starting TCAs, rise slowly to prevent falls, increase fluids and fiber to combat dry mouth and constipation.
MAOIs (Monoamine Oxidase Inhibitors)
- Used for depression; block the enzyme monoamine oxidase, increasing epinephrine, norepinephrine, dopamine, and serotonin.
- Medications can be remembered by the acronym "TIP": Tranylcypromine, Isocarboxazid, Phenelzine.
- Must not be combined with SSRIs or TCAs; require a 14-day washout period.
- Require a tyramine-restricted diet to prevent hypertensive crisis; avoid aged cheeses, fermented meats, overripe fruits, sour cream, and yogurt.
- Take in the morning due to risk of sleep disturbances.
- May take 4 weeks to achieve therapeutic effects; stress compliance with patients.
Key Terms & Definitions
- Serotonin Syndrome — Life-threatening condition with excessive serotonin causing rigidity, agitation, and vital sign changes.
- Anticholinergic Effects — Side effects such as dry mouth, blurred vision, constipation, and urinary retention.
- Tyramine — An amino acid in certain foods that can cause hypertensive crisis when combined with MAOIs.
- Washout Period — Required time between stopping one antidepressant and starting another (usually 14 days).
Action Items / Next Steps
- Review the psychiatric medications section in your nursing school bundle or textbook.
- Memorize key drug suffixes and side effects for SSRIs, TCAs, and MAOIs.
- Practice patient education scenarios, especially for safety and compliance.