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Psychiatric Meds.

Medications for Depression

QuestionAnswer
How long does it take for antidepressant medication to reach full therapeutic benefits? Symptom relief can take 1-3 weeks, and possible 2-3 months for full therapeutic benefits.
What are the Tricyclic Antidpressants (TCAs)? Amitriptyline (Elavil); Imipramine (Tofranil); Doxepin (Sinequan); Nortriptyline (Aventyl); Amoxapine (Asendin); Trimipramine (Surmontil)
What are the therapeutic uses for TCAs? Depression, Depressive episodes of bipolar disorders
What are the side/adverse effects of TCAs? Orthostatic hypotension; Anticholinerfic effects (dry mouth, blurred vision, photophobia, urinary hesitancy or rentention, constipation, tachycardia); Sedation; Toxicity: (dysrhythmias, mental confusion, agitation, seizure, coma, death)
Side/adverse effects of TCAs continued... Decreased seizure threashold; excessive sweating
Contraindications for TCAs Contraindicated for clients who have seizure disorders
Interactions with TCAs Avoid concurrent use of TCAs and MAOIs--can cause hypertension Avoid concurrent use of TCAs and antihistamines Avoid other CNS depressants (ETOH, benzos, opioids, and antihistamines)
What are the SSRIs? Fluoxetine (Prozac); Citalopram (Celexa); Escitalopram (Lexapro); Paroxetine (Paxil); Sertraline (Zoloft)
What are the therapeutic uses for SSRIs? Major Depression, OCD, Bulimia Nervosa, Premenstrual Dysphoric Disorders, Panic Disorders, Posttraumatic Disorder
What are the side/adverse effects of SSRIs? Sexual dysfunction; CNS stimulation (inability to sleep); weight loss early in therapy followed by a weight gain with long-term treatment;
Side/adverse effects of SSRIs continued... Serotonin Syndrome: mental confusion, difficulty concentrating, agitation, fever, anxiety, hallucinations, hyperreflexia, incoordination, diaphoresis, tremors Withdrawal Syndrome; Hyponatremia; Rash; Sleepiness; GI bleeding; Bruxism
Contraindications of SSRIs Contraindicated in clients taking MAOIs or TCAs
Interactions with SSRIs Concurrent use with MAOIs, TCAs, St. John's Wort increases the risk of serotonin syndrome. Concurrent use with warfarin (Coumadin) Concurrent use with tricyclic antidepressants and lithium Concurrent use with NSAIDs and anticoagulants
What are the Monoamine Oxidase Inhibitors (MAOIs)? Phenelzine (Nardil); Isocarboxazid (Marplan); Tranylcypromine (Parnate); Selefiline (Emsam)--transdermal patch
What are the therapeutic uses of MAOIs? Atypical Depression, Bulimia Nervosa, OCD
What are the side/adverse effects of MAOIs? CNS Stimulation; Orthostatic hypotension; HYPERTENSIVE CRISIS (resulting from intake of tyramine): headache, nausea, increased HR, increased BP--administer phentolamine (Regitine)IV, or nifedipine (Procardia)
Contraindications for MAOIs Contraindicated in clients taking SSRIs Use cautiously with clients with diabetes and/or seizure disorders, or those taking TCAs
Interactions with MAOIs Concurrent use with indirect-acting sympathomimetic meds (ephedrine, amphetamine) can lead to hypertensive crisis--avoid OTC decongestants and cold remedies Concurrent use with TCAs can lead to hypertensive crisis
Interactions with MAOIs continued... Concurrent use with SSRIs can lead to serotonin syndrome Concurrent use with Demerol can lead to hyperpyrexia
What is Hypertensive Crisis? HYPERTENSIVE CRISIS is when a client has severe hypertension as a result of intensive vasoconstriction and stimulation of the heart; can result from intake of dietary tyramine. S/S: headache, nausea, increased HR, increased BP
What are some tyramine-rich foods? Aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein, some dietary supplements, some beers, and red wine.
Interactions with MAOIs continued... Concurrent use with vaso-supressors may result in hypertension. Avoid foods that contain these (caffeinated beverages, chocolate, fava beans, ginseng)
What are the Atypical Antidepressants? Bupropion (Wellbutrin)
What are the therapeutic uses of Wellbutrin? Treatment of depression, aid to quit smoking, alternative to SSRIs for clients unable to tolerate the sexual dysfunction side effects, prevention of SAD
What are the side/adverse effects of Wellbutrin? Headache, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, insomnia Suppression of appetite (weight loss) Seizures
Contraindications for Wellbutrin Used cautiously in clients with a seizure disorder Contraindicated in clients taking MAOIs
What are Other Atypical Antidepressants? Venlafaxine (Effexor); duloxetine (Cymbalta); Mirtazapine (Remeron); Reboxetine (Edronax); Trazodone (Desyrel)
Created by: j_bressette
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