CHAPTER 16
DRUGS FOR EMOTIONAL AND MOOD DISORDERS
LEARNING OUTCOME 1
Identify the two major categories of mood disorders and their symptoms.
Concepts
1. Depression is a disorder characterized by a sad or despondent mood. Many symptoms are associated with
depression, including lack of energy; sleep disturbances; abnormal eating patterns; and feelings of despair,
guilt, and hopelessness. Depression is the most common form of mental illness in the United States.
2. Bipolar disorder, once known as manic depression or bipolar depression is characterized by extreme and
opposite moods, episodes of depression that alternate with episodes of mania. Patients may oscillate rapidly
between both extremes, or there may be prolonged periods when their mood is normal. Depressive
symptoms are the same as defined earlier. Mania is characterized by excessive CNS stimulation that results
in agitation, excessive talking, elevated mood, grandiose thoughts, flight of ideas, constant movement,
impulsive behavior, inflated self-esteem, racing thoughts, and short attention span. These symptoms must be
present for at least one week.
LEARNING OUTCOME 2
Identify the symptoms of attention deficit-hyperactivity disorder.
Concepts
Attention deficit/hyperactivity disorder (ADHD) is a condition characterized by poor attention span, behavior
control issues, and/or hyperactivity. Although normally diagnosed in childhood, ADHD may extend into
adulthood. The symptoms may include developmentally inappropriate behaviors involving difficulty in paying
attention or focusing on tasks. ADHD may be diagnosed when the child’s hyperactive behaviors significantly
interfere with normal play, sleep, or learning activities. Increased motor activity is manifested by a tendency to
be fidgety and impulsive and to interrupt and talk excessively. Children with this disorder may not be able to
interact with others appropriately.
LEARNING OUTCOME 3
Explain the etiology of major depressive disorder.
Concepts
Depression is associated with dysfunction of neurotransmitters in certain regions of the brain. Some women
experience intense mood shifts associated with hormonal changes during the menstrual cycle, pregnancy,
childbirth, and menopause. Seasonal affective disorder (SAD) is a type of depression that is associated with a
reduced release of the brain neurohormone melatonin.
LEARNING OUTCOME 4
Discuss the nurse’s role in the pharmacologic management of patients with depression, bipolar disorder,
or attention deficit-hyperactivity disorder.
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Concepts
1. The role of the nurse with patients on medication for emotional and mood disorders involves careful
monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment.
Assessing previous health history is essential, as conditions such as epilepsy, urinary retention, narrow angle
glaucoma, and prostatic hypertrophy may be affected. Assess the patient’s needs for antidepressant therapy
by noting the intensity and duration of the patient’s symptoms and identifying factors that lead to
depression, such as life events and health changes. Obtain a careful drug history, including the use of CNS
depressants, alcohol, and other antidepressants. Ask the patient about suicidal ideation, because the
medication may take several weeks before full therapeutic benefit is obtained. Obtain a history of any
disorders of sexual function and eating disorders. The patient may suffer from sexual dysfunction and
weight gain. Obtain baseline vital signs, liver- and renal-function tests, cardiovascular status, and baseline
body weight, as well as therapeutic blood levels as treatment continues. Information should include diet
education related to foods that contain tyramine and information on signs and symptoms of lithium toxicity.
2. Antidepressants: Monitor vital signs. Monitor for dizziness, headache, tremor, nausea/vomiting, anxiety,
disorientation, hyperreflexia, diaphoresis, and fever. These are signs of serotonin syndrome. Monitor
neurologic and cardiovascular status. Monitor mental and emotional status. Monitor for underlying
psychoses. Monitor sleep–wake cycle. Monitor renal and gastrointestinal status. Monitor liver function and
hematologic status. Monitor visual acuity. Ensure patient safety.
3. Mood stabilizers: Monitor mental and emotional status. Monitor electrolyte balance, fluid balance, and I &
O. Monitor renal and cardiovascular, as well as gastrointestinal, status.
4. Attention deficit/hyperactivity disorder: Monitor mental status. Monitor vital signs and gastrointestinal and
nutritional status. Monitor laboratory tests as well as the effectiveness of drug therapy. Monitor growth and
development and sleep–wake cycle.
LEARNING OUTCOME 5
For each of the drug classes listed in Drugs at a Glance, recognize representative drug examples, and explain
their mechanism of action, primary actions, and important adverse effects.
Concepts
1. Antidepressants: Tricyclic antidepressants (TCA): The prototype drug is imipramine (Trofranil). The
mechanism of action is inhibiting the reuptake of both norepinephrine and serotonins into presynaptic nerve
terminals. The primary use is mainly for major depression and occasionally for milder situational
depression. The adverse effects observed are orthostatic hypotension and rarely seen cardiac dysrhythmias.
Sedation and anticholinergic effect are a common complaint but are generally more tolerable after several
weeks of treatment. Selective serotonin reuptake inhibitors (SSRIs): The prototype drug is sertralline
(Zoloft). The mechanism of action is to slow the reuptake of serotonin into presynaptic nerve terminals so
that postsynaptic receptors become more sensitive. The primary use is in the treatment of depression
because of their improved side effects. The most common side effects are sexual dysfunction, nausea,
headache, weight gain, anxiety, and insomnia. Less common adverse effects include sedation,
anticholinergic effects, and sympathomimetic effects.
2. Atypical antidepressants: Serotonin-norepinephrine reuptake inhibitors (SNRIs). The prototype drug is
bupropion (Wellbutrin). The mechanism of action is to inhibit the reuptake of serotonin and affect the
activity of norepinephrine and dopamine. The primary use is for depression. Adverse effects include sexual
dysfunction, nausea, headache, weight gain, anxiety, and insomnia.
3. MAO inhibitors (MAOI): The prototype drug is phenelzine (Nardil). The mechanism of action is to decrease
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the effectiveness of the enzyme monoamine oxidase. The MAOIs limit the breakdown of norepinephrine,
dopamine, and serotonin in CNS neurons. The primary use is to reduce the symptoms of depression.
Common adverse effects of the MAOIs include orthostatic hypotension, headache, insomnia, and diarrhea.
A primary concern is that these agents interact with a large number of foods and other medications,
sometimes with serious effects.
4. Mood stabilizers: The prototype drug is lithium carbonate (Eskalith). The mechanism of action is sodium
transport across cell membranes. The primary use is for bipolar disorder. The side effect may be excessive
loss of sodium.
5. CNS stimulants: The prototype drug is methylphenidate hydrochloride (Ritalin). The mechanism of action is
to stimulate specific areas of the CNS that heighten awareness and increase focus. The primary use is for
ADHD. The adverse effects include insomnia, nervousness, anorexia, and weight loss.
LEARNING OUTCOME 6
Categorize drugs used for mood and emotional disorders based on their classification and drug action.
Concepts
1. Antidepressants: Tricyclic antidepressants are used mainly for major depression and affect the reuptake of
norepinephrine and serotonin. Examples are Elavil, Ludiomil, and Asendin. Selective serotonin reuptake
inhibitors are used for depression and slow the reuptake of serotonin. Examples are Celexa, Lexapro, and
Paxil.
2. Atypical antidepressants are used for depression; they inhibit the reuptake of serotonin and affect the
activity of norepinephrine and dopamine. Examples are Remeron, Serzone, and Effexor.
3. MAO inhibitors reduce the symptoms of depression, by decreasing the effectiveness of the enzyme
monoamine oxidase; the MAOIs limit the breakdown of norepinephrine, dopamine, and serotonin in CNS
neurons. Examples are Marplan, Nardil, and Parnate.
4. Mood stabilizers are used for bipolar disorder and transport sodium across cell membranes. An example is
lithium carbonate.
5. CNS stimulants are used for ADHD and stimulate specific areas of the CNS that heighten awareness and
increase focus. Examples are Adderall, Dexedrine, and Desoxyn.

Patients Receiving Lithium (Eskalith)

Patients Receiving Methylphenidate (Ritalin)
LEARNING OUTCOME 7
Use the nursing process to care for patients receiving drug therapy for mood and emotional disorders.
Concepts
1. Assessment: Assess previous health history. Assess the patient’s need for antidepressant therapy by noting
the intensity and duration of the patient’s symptoms and identifying factors that led to depression. Obtain a
careful drug history. Ask the patient about suicidal ideation. Obtain a history of any disorders of sexual
function and eating disorders. Obtain laboratory tests as ordered by the physician, including baseline V/S
and body weight; monitor therapeutic blood levels as treatment continues.
2. Nursing diagnoses: ineffective coping, disturbed thought processes related to side effects of the drug, and
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knowledge deficient, related to drug therapy.
3. Planning: Goals for patients receiving antidepressants include the patient’s ability to explain depression and
the medications needed to treat the condition.
4. Implementation: Encourage compliance with the medication regimen. Provide additional education
regarding medication regimen with a clinical pharmacist and dietician.
5. Evaluation: Ideal outcome criteria for evaluation of the plan of care are to control the symptoms of
emotional and mood disorders with limited side effects and no organ damage or injury. Patients are able to
verbalize the importance of taking the prescribed medications.
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