Antidepressant and mood stabilizing
agent
Safa Mansour Othman
Tips to be Covered







Antidepressants
Definition.
what conditions are antidepressants used??
Are there differences among antidepressants?
What are side effects of antidepressants?
Mood stabilizer agent.
Questions.
Definition


Antidepressants:
are a class of drugs that reduce symptoms of
depressive disorders by correcting chemical
imbalances of neurotransmitters in the brain.
Chemical imbalances may be responsible for
changes in mood and behavior.
Definition
Neurotransmitters are vital, as they are the communication
link between nerve cells in the brain. Neurotransmitters
reside within vesicles found in nerve cells, which are
released by one nerve and taken up by other nerves.
Neurotransmitters not taken up by other nerves are taken
up by the same nerves that released them. This process
is called "reuptake." The prevalent neurotransmitters in
the brain specific to depression are serotonin, dopamine
and norepinephrine (also called noradrenaline).
Definition

n general, antidepressants work by inhibiting the
reuptake of specific neurotransmitters, hence
increasing their levels around the nerves within the
brain, such as selective serotonin reuptake inhibitors
(SSRIs), antidepressants that will affect serotonin
levels in the brain.
conditions are antidepressants
used
Antidepressants are used to treat several
conditions. They include, but are not limited to:
depression, generalized anxiety disorder,
agitation, obsessive compulsive
disorders (OCD), manic-depressive disorders,
childhood enuresis (bedwetting), major
depressive disorder, diabetic peripheral
neuropathic pain, neuropathic pain, social
anxiety disorder, posttraumatic stress
disorder (PTSD) etc.
conditions are antidepressants
used

Some off- label uses of antidepressants
include, but are not limited
to:fibromyalgia, chronic urticaria (hives), hot
flashes, hyperhidrosis (druginduced), pruritus (itching), premenstrual
symptoms, bulimia nervosa,Tourette
syndrome, binge eating disorder, etc.
Are there differences among
antidepressants?
Antidepressants differ in their effects on neurotransmitters,
established uses, adverse effects and drug interactions.
All antidepressants that are used for depression are
effective; there is no evidence that one antidepressant is
more effective than another. However, patients may
respond to or tolerate one antidepressant, and not
respond to or tolerate another antidepressant.
What are side effects of antidepressants?

Antidepressants that belong to the same class of
antidepressant produce similar side effects.
Antidepressants may cause withdrawal symptoms if
abruptly discontinued. Withdrawal symptoms
include nausea, vomiting, dizziness, headache,
irritability, sleep disturbance, nightmares, psychosis,
and seizures.
What are side effects of antidepressants?

All antidepressants have a warning about use in children and
adolescents. Antidepressants increased the risk of suicidal
thinking, and suicidal behavior in short-term studies in children
and adolescents with depression and other psychiatric disorders.
Anyone considering the use of antidepressant in a child or
adolescent must balance this risk of suicide with the clinical need
for the drug. Patients who are started on therapy should be closely
observed for clinical worsening, suicidal thoughts or unusual
changes in behavior.
Tricyclic antidepressants (TCAs)
side effects

Tricyclic antidepressants (TCAs) are a class of
antidepressant associated with sedation, dry
mouth, blurred vision, constipation, urinary
retention, and increased pressure in the eye.
Tricyclic antidepressants (TCAs)
side effects

They are also associated with
hypertension, abnormal heart rhythms,
anxiety, insomnia, seizures, headache, rash,
nausea, and vomiting, abdominal cramps, weight
loss, and sexual dysfunction. Tricyclic
antidepressants rarely cause liver failure.
Selective serotonin reuptake
inhibitors (SSRIs) side effects
Selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine
reuptake inhibitors (SNRIs) are two classes of antidepressants associated
with :
abnormal thinking, agitation, anxiety, dizziness, headache, insomnia, sexual
dysfunction, sedation, tremor, sweating, weight loss, diarrhea, constipation,
dry mouth, rash, and nausea. Rarely, SSRIs have been associated with
hyponatremia (low sodium),hypoglycemia (low blood glucose), and seizures.
Monoamine oxidize inhibitors
(MAOIs) side effects
Monoamine
oxidize inhibitors (MAOIs) are
a class of antidepressant associated with
postural hypotension (feeling faint upon
standing due to decreased blood flow to the
brain
Monoamine oxidize inhibitors
(MAOIs) side effects

high blood pressure, fainting, abnormal heart
rhythm, dizziness, headache, drowsiness,
insomnia, anxiety, constipation, nausea,
diarrhea, sexual dysfunction, weight gain or
weight loss, and edema. Seizures, rash,
blurred vision, and hepatitis are infrequently
associated with MAOIs.
What are the possible drug interactions?
Tricyclic antidepressants (TCAs)
•
Combining tricyclic antidepressants
(TCAs) with clonidine (Catapres) may lead to
dangerous elevations in blood pressure because TCA
may inhibit the antihypertensive effect of clonidine.
What are the possible drug interactions?
Tricyclic antidepressants (TCAs)
•
Combining TCAs with carbamazepine (Tegretol)
may result in lower TCA blood levels and higher
carbamazepine levels, leading to decreased TCA
efficacy or increased carbamazepine toxicity.
What are the possible drug interactions?
Tricyclic antidepressants (TCAs)

TCAs may increase the effects of epinephrine,
norepinephrine and dopamine. Dangerous increases in
blood pressure and abnormal heartbeats may
occur. Cimetidine (Tagamet) may reduce the
breakdown of some TCAs [for
example, amitriptyline (Elavil)] and potentially lead to
increased side effects.
Selective serotonin reuptake
inhibitors (SSRIs) interactions

Selective serotonin reuptake inhibitors (SSRIs) should
not be combined with other drugs that increase brain
serotonin levels [for example, MAOIs,
TCAs, sumatriptan (Imitrex), linezolid(Zyvox), St John's
Wort, amphetamines] because there is a risk of
dangerous adverse effects. The risk of gastrointestinal
bleeding may be increased when SSRIs are combined
with nonsteroidal antiinflammatory drugs (NSAIDs).
Monoamine oxidize inhibitors
(MAOIs) interactions

Monoamine oxidize inhibitors (MAOIs) should not be
combined with other antidepressants or other drugs
that increase serotonin levels [for example,
amphetamines, linezolid (Zyvox), St. Johns Wort,
sumatriptan (Imitrex)]. Such combinations cause
excessive serotonin levels in the brain, which may lead
to confusion, high blood pressure, tremor,
hyperactivity, coma, and death.
Count's

Administration of MAOIs and other antidepressants or
drugs that elevate serotonin should be separated by 14
days. Administration of MAOIs with epinephrine,
norepinephrine, phenylephrine, pseudoephedrine, and
dopamine may lead to hypertensive crisis. MAOIs
interact with tyramine containing foods, resulting in a
hypertensive crisis.
Examples of Antidepressants - Tricyclic
antidepressants (TCA)









amitriptyline (Elavil)
amoxapine
clomipramine (Anafranil)
desipramine (Norpramin)
doxepin (Sinequan)
imipramine (Tofranil)
nortriptyline (Pamelor)
protriptyline (Vivactil)
trimipramine (Surmontil)
Selective Serotonin Reuptake Inhibitors






citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac, Sarafem)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)

Monoamine Oxidize Inhibitors:

phenelzine (Nardil)
tranylcypromine (Parnate)
isocarboxazid (Marplan)
selegiline (EMSAM, Eldepryl)




Other Antidepressants:

maprotiline Mirtazapine (Remeron)
trazodone Bupropion (Wellbutrin)
nefazodone (Serzone)


Diagnosis



The following nursing diagnosis may be
consider the clients receiving therapy with
antidepressant medication :
1-risk for suicide rt depressed mood.
2-risk for injury rt side effect of medication,
orthostatic hypotension , photosensitivity ,
arrhythmias , hypertensive crisis or serotonin
syndrome .


3-social isolation rt depressed mood.
4-costipation rt side effect of the medication.
Planning / implementation

The plan of care should include monitoring the
side effects from antidepressant medication .
Nursing implications:

Note (In the following slide )

Mood stabilizer:
A mood stabilizer is a psychiatric
medication used to treat mood
disorders characterized by intense and
sustained mood shifts, typically bipolar
disorder.
Uses:
Used to treat bipolar disorder,[1] mood
stabilizers suppress swings
between mania and depression. Moodstabilizing drugs are also used in borderline
personality disorder[2] and schizoaffective
disorder.
Lithium Carbonate

WARNINGS: It is very important to have the
right amount of lithium in your body. Too much
lithium may lead to unwanted effects such as
nausea, diarrhea, shaking of the
hands, dizziness, twitching, seizures, slurred
speech, confusion, or increase in the amount
of urine. Tell your doctor immediately if these
effects occur.


Note
The remaining things with safa
The Nursing Process: MoodStabilizing Agents
Background assessment data


Indications: prevention and treatment of manic
episodes associated with bipolar disorder
Examples: lithium carbonate, clonazepam,
carbamazepine, valproic acid, lamotrigine,
gabapentin, topiramate, verapamil, olanzapine
The Nursing Process: Mood-Stabilizing
Agents (cont.)
Background assessment data (cont.)



Action: lithium enhances the reuptake of
norepinephrine and serotonin in the brain,
lowering levels in the body and resulting in
decreased hyperactivity. Action of
anticonvulsants, verapamil, and olanzapine in
the treatment of bipolar disorder is not fully
understood.
Interactions
Contraindications/precautions
The Nursing Process: Mood-Stabilizing
Agents (cont.)
Nursing diagnosis
Risk for injury
 Risk for self-directed or
other-directed violence
 Risk for activity intolerance

The Nursing Process: MoodStabilizing Agents (cont.)
Planning/implementation
Monitor for side effects of lithium
 Drowsiness, dizziness, headache
 Dry mouth; thirst; GI upset; nausea/vomiting
 Fine hand tremors
 Hypotension; arrhythmias, pulse irregularities
 Polyuria; dehydration
 Weight gain
 Potential for toxicity
The Nursing Process: MoodStabilizing Agents (cont.)

Lithium Toxicity

Therapeutic range: 1.0–1.5 mEq/L
Initial symptoms of toxicity include

–

Blurred vision, ataxia, tinnitus,
persistent nausea and vomiting,
and severe diarrhea
Ensure that client consumes adequate
sodium and fluid in diet
The Nursing Process: Mood-Stabilizing
Agents (cont.)
Planning/implementation (cont.)
Monitor for side effects of anticonvulsants
 Nausea and vomiting
 Drowsiness; dizziness
 Blood dyscrasias
 Prolonged bleeding time (with valproic acid)
 Risk of severe rash (with lamotrigine)
 Decreased efficacy with oral contraceptives
(with topiramate)
The Nursing Process: Mood-Stabilizing
Agents (cont.)
Planning/implementation (cont.)
Monitor for side effects of verapamil
 Drowsiness; dizziness
 Hypotension; bradycardia
 Nausea
 Constipation
The Nursing Process: MoodStabilizing Agents (cont.)
Planning/implementation (cont.)
Monitor for side effects of olanzapine
 Somnolence, dizziness, asthenia
 Fever; tachycardia
 Postural hypotension
 Dry mouth
 Constipation
 Increased appetite; weight gain
The Nursing Process: Mood-Stabilizing
Agents (cont.)

Planning/implementation (cont.)
–

Educate client and family about the medication
Outcome Criteria/Evaluation
Questions:
thank
you