Antidepressant Drugs (EDGT Module 2)

What is included in patient teaching for SSRIs?

• Do not take concurrently with an MAO inhibitor. This could lead to serious -- even fatal -- reactions. • Do not stop taking the drug or increase the dose without your prescriber's approval. • If a dose is forgotten, take it as soon as remembered. If it is almost time for the next dose, the dose should be skipped, then return to your regular schedule. Doses should never be doubled. • Your depression will begin to lift in 1 to 4 weeks, but it takes several months for the medication to yield its full benefit. • The SSRI you are taking may interact with other drugs - both prescription and over-the-counter. These drugs may also interact with herbal supplements. Consult with your physician before taking new drugs or herbal supplements. Be sure to tell your physician about any drugs or supplements you are taking if you are prescribed an antidepressant. • Avoid using alcohol or engaging in tasks that require alertness until your response to the drug is established. • The effects of the SSRIs during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, contact your doctor immediately. • Some of the SSRIs appear in breast milk and will affect your infant. You may need to choose between breast feeding and SSRI therapy. Antidepressants may increase the risk of suicidal thinking and behavior, especially in children, adolescents,and young adults. You should report any increase in suicidal thoughts and behaviors. Your families should be taught to monitor you for any increase in suicidal thoughts and behaviors as well.

What is included in patient teaching for TCAs?

Abrupt discontinuation of TCAs may cause intensification of adverse effects, headaches, nausea, and lethargy. Do not use a TCA in conjunction with MAO inhibitors. Your depression will begin to lift in 1 to 4 weeks, but it takes several months for the medication to yield its full benefit. If a dose is forgotten, take it as soon as remembered. If it is almost time for the next dose, the dose should be skipped, then return to your regular schedule. Doses should never be doubled. Use of alcohol concurrently with TCAs is contraindicated because of the chance of increased central nervous system depression. Using evening primrose concurrently with TCAs increases the likelihood of seizures. Simultaneous use of St. John's Wort can lead to a toxic state called serotonin syndrome. Smoking may decrease drug levels. There is an increased risk of photosensitivity if clients are exposed to the sun. TCA therapy is best avoided during pregnancy. If you are pregnant or plan to become pregnant, contact your doctor immediately. You should not take TCAs with SSRIs. Doing so may cause dangerous side effects. The TCA you are taking may interact with other drugs - both prescription and over-the-counter. These drugs may also interact with herbal supplements. Consult with your physician before taking new drugs or herbal supplements. Be sure to tell your physician about any drugs or supplements you are taking if you are prescribed an antidepressant. Antidepressants may increase the risk of suicidal thinking and behavior, especially in children, adolescents,and young adults. You should report any increase in suicidal thoughts and behaviors. Your families should be taught to monitor you for any increase in suicidal thoughts and behaviors as well.

How is serotonin syndrome treated?

Airway maintenance and oxygen therapy if needed Immediate treatment with activated charcoal in case of an overdose Intensive, aggressive, and supportive care as needed Cardiopulmonary stabilization with treatment of hypertension or hypotension Keeping the client safe while he/she is delirious and agitated Sedation with benzodiazepines, such as Valium, Librium, Xanax Treatment for hyperthermia with benzodiazepines or aggressive cooling All serotonergic medications stopped immediately Administration of a serotonin antagonist, such as Cyproheptadine (Periactin)

What is some information on atypical antidepressants?

Along with the SSRIs, the atypical antidepressants join the classification entitled the second-generation antidepressants. They appear to act in ways similar to the TCAs and the SSRIs. They are generally prescribed when the SSRIs do not seem to be effective in relieving the client's depressive symptoms.

What are situations where serotonin syndrome may occur?

As the result of an intentional overdose in a suicide attempt In clients with impaired hepatic or renal function From interactions with other drugs - prescribed or over-the-counter If clients take more of the prescribed drug(s) to accelerate their therapy

How do atypical antidepressants work in the body?

Atypical antidepressants appear to act in ways similar to TCAs and the SSRIs. They selectively block the repute of norepinephrine or serotonin or both, thus increasing the amounts of these neurotransmitters in the synapses between neurons.

What is Celexa (citalopram) commonly used for, dosages, and important information?

Celexa (citalopram) is used to treat major depression. It is also being investigated for the treatment of alcoholism, panic disorder, premenstrual dysphoria, post-traumatic stress disorder, and social phobia. Dosage Forms: Tablets: 10, 20, 40 mg Solution: 10 mg/5 mL Adults: Initial dose 20 mg daily. May be increased to 40 mg daily after a minimum of 1 week. Maximum dose 40 mg daily. Elderly: 20 mg per day, adjusted to 40 mg per day only for unresponsive clients. Must not be taken for 2 weeks before or after therapy with an MAO inhibitor such as Parnate or Nardil. Combining Celexa with one of these drugs could lead to serious or even fatal reactions. Celexa should be taken once a day, in the morning or evening, with or without food. There is a slight chance that Celexa will trigger a manic episode. It should be used with caution in clients who suffer from bipolar disorder. Safety and efficacy have not yet been determined for children. Pregnancy Category: C. Used only in pregnancy if benefits outweigh risks.

What are common side effects of SSRIs?

Clients who are taking SSRIs should be monitored for sleep disturbances, gastrointestinal problems, and changes in libido and sexual functioning. Additional common side effects include headache, fatigue, vaginal dryness, anxiety, tremor, dizziness, dry mouth, excessive sweating. Most are in the FDA Pregnancy Category: C. Some appear in breast milk.

What are 3 commonly prescribed SNRIs?

Cymbalta (duloxetine) Effexor (venlafaxine) Pristiq (desvenlafaxine)

What are 5 commonly prescribed atypical antidepressants?

Cymbalta (duloxetine) (SNRI-info above) Desyrel (trazodone) Effexor (venlafaxine) (SNRI- info above) Remeron (mirtazapine) Wellbutrin (bupropion)

What is Cymbalta (duloxetine) commonly used for, dosages, and important information?

Cymbalta is also used to treat diabetic peripheral neuropathy, a painful nerve disorder associated with diabetes that affects the hands, legs, and feet. Dosage Forms: Capsules (delayed-release): 20 mg, 30 mg, 60 mg Adults: (for major depressive disorder) Initially 20 mg P.O. bid, then 60 mg P.O. once daily or divided into two equal doses. Maximum dose: 60 mg daily. Adults: (for neuropathic pain) 60 mg P.O. once daily ALERT -- Warn families or caregivers to report signs of worsening depression or signs of suicidal behavior to the prescriber immediately. Tell client to consult prescriber if he/she plans to take other prescription drugs, OTC drugs, or a herbal or dietary supplement. Instruct client to swallow the capsule whole and not to chew, crush, or open the capsule. Urge client to avoid activities that are hazardous or require mental alertness until the effects of the drug are known. Warn the client to avoid drinking substantial amounts of alcohol while taking the drug. Avoid use during pregnancy. Carefully weigh benefits to mother versus risks to fetus. Its safety and effectiveness has not been established in children. Clients should be closely monitored for signs of serotonin syndrome which, if severe, can be deadly.

What is Desyrel (trazodone) commonly used for, dosages, and important information?

Desyrel (trazodone) is a heterocyclic introduced in the 1980s after the TCAs. It is thought to potentiate serotonin through receptor antagonism and is prescribed because of its virtual lack of anticholinergic side effects and its low potential for adverse cardiac effects. It is used primarily to treat depression. Dosage Forms: Tablets: 50, 100, 150, 300 mg Adults: Initially 150 mg PO daily in divided dosages. Increased by 50 mg daily every 3 to 4 days as needed. Maximum dose: 400 mg for outpatients and 600 mg for hospitalized clients. Elderly: Initially 25 to 50 mg at bedtime. Maximum dose: 150 mg daily. Desyrel should not be used concurrently with an MAO inhibitor. Recent information indicates that Desyrel interacts with some drugs to elevate its serum levels and heighten the risk of adverse effects. Changes in labeling of the drug have been recommended. Priapism (painful, prolonged penile erection) may occur. Tell client to immediately stop the drug and seek immediate medical advice. Should be taken after meals or with a snack. May be given at bedtime if drowsiness occurs. Clients should be monitored for suicidal tendencies or suicidal thoughts and only given a minimum supply of the drug. Photosensitivity may occur. Pregnancy risk category C. Safety has not been established during pregnancy. The safety and effectiveness of the drug for children under the age of 18 has not been established.

What are 6 commonly prescribed TCAs?

Doxepin Hydrochloride Anafranil (clomipramine) Elavil (amitriptyline) Norpramin (desipramine) Pamelor (nortriptyline) Tofranil (imipramine)

What is Doxepin Hydrochloride commonly used for, dosages, and important information?

Doxepin Hydrochloride is a TCA that mostly potentiates serotonin. It is sedating and claimed to be a drug that effectively enhances sleep and reduces anxiety. In addition, it is generally well tolerated by cardiac patients. Doxepin Hydrochloride is used in the treatment of major depression and anxiety. It is effective in treating clients whose depression is psychological, associated with alcoholism, or the results of another disease, such as cancer. It is also prescibed for depression in bipolar disorder. Dosage Forms: Capsules: 10, 25, 50, 75, 100, 150 mg Oral Solution: 10 mg/mL Adults: Initially, 50 to 75 mg/day, may increase to 300 mg/day for severly ill; give in divided doses if > 150 mg/day. Maximum: 300 mg daily. Elderly: Initially 25 to 50 mg at bedtime, increase weekly by 25 to 50 mg to desired dose. Maximum: 150 mg daily Avoid taking with or within two weeks of an MAO inhibitor. The full dose should be taken at bedtime whenever possible. Warn client of potential morning dizziness if standing up quickly. Tell client to dilute the oral concentrate with 4 ounces of water, juice (not grape), or milk. It should not be mixed with carbonated beverages. This drug should not be combined with alcohol. This drug should not be stopped abruptly. Clients should be monitored for suicidal tendencies or suicidal thoughts and only given a minimal supply of the drug. Avoid use during pregnancy/nursing. To prevent sensitivity to the sun, advise patient to use sunblock, wear protective clothing, and avoid prolonged exposure to strong sunlight.

What are signs and symptoms of serotonin syndrome?

Early signs and symptoms include mental changes, such as confusion, delirium, anxiety, restlessness, and agitation. The two most useful symptoms are hyperreflexia (increased reflex reactions) and clonus (rapid alternating involuntary contraction and relaxation of the skeletal muscles). Other signs include: Fever Dilated pupils Hyperactive bowel sounds and diarrhea Presence or absence of diaphoresis

What is Effexor (venlafaxine) commonly used for, dosages, and important information?

Effexor is prescribed for depression. Effexor XR (sustained release) is also prescribed to relieve generalized anxiety disorder. Dosage Forms: Extended-Release Capsules: 37.5 mg, 75 mg, 150 mg Tablets: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg Adults: (tablets) 75 mg daily in 2 or 3 divided doses with food. May be increased in increments of 75 mg per day at no less than 4 day intervals. Maximum dose: Usually 225 mg daily. For severely depressed 375 mg per day. Adults: (Extended-release capsules) 75 mg daily PO daily in single dose. May be increased in increments of 75 mg per day every 4 days. Maximum dose: 225 mg daily. Effexor should be taken with food and exactly as prescribed. It may take several weeks before an effect is seen. It should not be used concurrently with a MAOI - may cause a syndrome similar to neuroleptic malignant syndrome with a high fever, tachycardia, tachypnea, and profuse diaphoresis. It should be used with caution in clients with high blood pressure, glaucoma, heart, liver, or kidney disease, or in clients with histories of seizure or mania. Clients should be monitored for suicidal tendencies and only given a minimal supply of the drug. Its effect during pregnancy has not been adequately studied. It does appear in breast milk and may cause serious side effects in nursing infants. Its safety and effectiveness has not been established in children under the age of 18. Clients should be closely monitored for signs of serotonin syndrome which, if severe, can be deadly.

What are 4 commonly prescribed MAOIs?

Emsam (selegiline) Marplan (isocarboxazid) Nardil (phenelzine) Parnate (tranylcypromine)

What is Emsam (selegiline) commonly used for, dosages, and important information?

Emsam (selegiline) may inhibit MAO type B (mainly found in the brain) and dopamine metabolism. The transdermal patch formulation bypasses the digestive system so it has the benefit of no dietary restrictions, unlike other MAOIs. However, drug interactions still exist. Dosage Forms: Transdermal system: 6 mg/24 hours, 9 mg/24 hours, 12 mg/24 hours Adults: 6 mg/24 hours initially Increase, if needed, in increments of 3 mg/day at intervals of 2 or more weeks. Maximum daily dose, 12 mg. Use cautiously in pregnant or breastfeeding women. Do not use with children due to risk for hypertensive crisis. Efficacy and safety haven't been established for children younger than 12. Apply patch to dry, intact skin on the upper torso, upper thigh, or outer surface of the upper arm once every 24 hours. Do not cut the transdermal patch into smaller pieces. If condition hasn't improved after 2 weeks, review diagnosis. Stop drug if skin irritation or sensitivity develops.

What are some general contraindications for antidepressant drugs?

Hypersensitivity Acute recovery phase of myocardial infarction (MI) Women who are pregnant or lactating (breast feeding) Cautious use for elderly or debilitated clients Cautious use with clients with hepatic, renal, or cardiac insufficency. Most antidepressants are metabolized in the liver and excreted via the renal system. Cautious use for clients with benign prostatic hypertrophy Psychotic clients Cautious use in children and young adults

What are contraindications of MAOIs?

Hypersensitivity to drug. Concurrent use of sympathomimetics. Many OTC cold medications contain sympathomimetics. Concurrent use of SSRIs, TCAs, another MAOI, or Demerol (meperidine). Important: The MAOIs when combined with meperidine may cause hypertension, coma, convulsions, or death. Important: Ingestion of tyramine-containing foods or foods high in caffeine. These may cause a hypertensive crisis. Clients with a history of pheochromocytoma, hypertension, stroke, heart failure, hepatic or renal impairment. Clients undergoing elective surgery. Pregnancy.

What are contraindications of TCAs?

Hypersensitivity to the drug. Concurrent use with MAO inhibitors. Clients with glaucoma or a tendency for urinary retention. Cautious use in elderly clients. Clients with history of cardiovascular disease or during the acute recovery phase of an MI. Cautious use for clients with suicidal tendencies - overdoses common. Pregnancy.

What is Anafranil (clomipramine) commonly used for, dosages, and important information?

It is primarily indicated and used in the treatment of obsessive-compulsive disorder (OCD). However, it is also being used to treat panic disorder, depression, and chronic pain. Dosage Forms: Capsules: 25, 50, 75 mg Adults: Initially 25 mg PO daily with meals, gradually increased to 100 mg daily in divided doses during the first 2 weeks. Maximum dose 250 mg daily in divided doses. After dosage is adjusted, daily dose is totally given at bedtime. Children: Initially 25 mg per day with meals, gradually increased over the first 2 weeks to a maximum of 3 mg/kg/day in divided doses. Serious, even fatal, reactions have occurred when Anafranil is taken concurrently with an MAO inhibitor such as Parnate or Nardil. It should be taken with meals at first to prevent an upset stomach. After dosage has been established, it should be taken at night to prevent sleepiness during the day. This medicine can cause a dry mouth. Hard candy, chewing gum, and bits of ice may relieve this problem. Anafranil is contraindicated for clients with narrow-angle glaucoma, history of a recent heart attack, clients with limited kidney function, or those having difficulty urinating. The most significant risk is seizures. Men are likely to experience sexual dysfunction. Safety has not been established during pregnancy. It should only be used if benefits outweigh risks. Anafranil does appear in breast milk and does affect the nursing infant.

What is Elavil (amitriptyline) commonly used for, dosages, and important information?

It is used primarily to treat depression. However, it has also been prescribed for bulimia, chronic pain, migraine headaches, and the weeping and laughing syndrome associated with multiple sclerosis. Dosage Forms: Tablets: 10, 25, 50, 75, 100, 150 mg Adults: Initially 50 to 100 mg P.O. at bedtime. Maximum dose: 300 mg daily. Elderly and Adolescents:: Initially 10 P.O. t.i.d. and 20 mg at bedtime daily. Elavil should not be used concurrently with an MAO inhibitor. May be given at bedtime if drowsiness occurs. Tends to be sedating and can be administered at bedtime to enhance sleep. Has the greatest anticholinergic and antianxiety effects among the tertiary amines. May cause orthostatic hypotension. Tell clients to change positions slowly. Clients should be monitored for suicidal tendencies or suicidal thoughts. Pregnancy risk category C. Safety has not been established during pregnancy. The safety and effectiveness of the drug for children under the age of 18 has not been established.

What is Tofranil (imipramine) commonly used for, dosages, and important information?

It is used to treat depression as well as childhood enuresis in children age 5 or older. Some doctors also prescribe Tofranil (imipramine) for bulimia, attention deficit disorder in children, obsessive-compulsive disorder, and panic disorder. Dosage Forms: Capsules: 75, 100, 125, 150 mg Tablets: 10, 25, 50 mg Injection: 12.5 mg/ml Adults: Initially 75 to 100 mg PO (or rarely IM) per day in divided dosages. Increased in 25 or 50 mg increments. Maximum 200 mg for outpatients and 300 mg for hospitalized clients. Entire dose may also be given at bedtime. Elderly and Adolescents: Initially 30 to 40 mg daily. Maximum 100 mg daily. Childhood Enuresis (age 6 and older): 25 mg PO 1 hour before bedtime. If no response, increased to 50 mg is child if younger than 12 and 75 mg for child 12 and older. Maximum 2.5 mg/kg daily. Serious and sometimes fatal reactions may occur when this drug is taken concurrently with an MAO inhibitor. Tofranil is used on a short term basis only to treat bed-wetting in children. For children, the dose is given one hour before bedtime. As with the other TCAs, this drug should be used with caution in clients with a history of a recent heart attack, narrow-angle glaucoma, seizures, or heart, kidney, liver, or thyroid disorders. The drug should not be stopped abruptly. Overdoses may be fatal, especially in children. If overdose is suspected, immediate medical help must be summoned. The affects of Tofranil during pregnancy have not been adequately studied. It does appear in breast milk and could affect a nursing infant. Tofranil should only be used in children over 6 and used only to treat bed-wetting.

What is included in patient teaching for MAOIs?

It will take 10 days to 4 weeks before a full therapeutic effect is experienced. Driving should be avoided if sedation is pronounced. Rise slowly from lying position, sitting up first for 1 minute. Notify all of your prescribers that you are taking an MAOI. Consult with your prescriber before taking any OTC drugs. Avoid foods that contain a large amount of tyramine, such as anchovies, avocados, bananas, beer and ale, broad beans, canned figs, caffeinated coffee, colas, and tea, caviar, cheese, chocolate, dry sausage, liver, meat extract, meat tenderizers, pickled herring, raisins, sauerkraut, sour cream, soy sauce, yeast extract, yogurt, pickled, fermented, or smoked foods, chianti and sherry wine. A combination of these foods with an MAOI may result in a hypertensive crisis. Avoid ingesting alcohol. Report immediately any signs of a hypertensive crisis: headaches, palpitations, stiff neck. Do not stop the drug abruptly.

What is Lexapro (escitalopram) commonly used for, dosages, and important information?

Lexapro (escitalopram) is used for both treatment and maintenance therapy for clients with major depressive disorder. Dosage Forms: Tablets: 5, 10, 20 mg Oral solution: 5 mg/5 ml Adults: 10 mg once daily in morning or evening May be increased to 20 mg daily after a minimum of one week. Elderly: 10 mg daily The drug can be taken with or without food. Lexapro makes some clients sleepy. Tell the client to avoid tasks that require alertness until the effects of the drug on the CNS are established. It may cause sexual dysfunctions, such as ejaculation disorder, impotence, anorgasmia, and menstrual cramps. Encourage client to avoid alcohol while taking drug. Use cautiously in clients with suicidal ideation or clients with histories of mania or seizure disorders. Lexapro should be taken during pregnancy only if its benefits outweigh potential risk. Lexapro appears in breast milk and can affect a nursing infant.

What is Luvox (fluvoxamine) commonly used for, dosages, and important information?

Luvox (fluvoxamine) is used to treat obsessive-compulsive disorder (OCD) and depression. Dosage Forms: Tablets: 25, 50, 100 mg Adults: 50 mg at bedtime May be increased in 50 mg increments every 4 to 7 days. Maximum dose 300 mg per day. Children: 8 to 17 25 mg at bedtime May be increased by 25 mg increments every 4 to 7 days. Maximum dose 200 mg per day for children ages 8 to 11 and 300 mg for children 11 to 17. Elderly: lower initial doses and slower dose adjustments recommended. Luvox should be taken at bedtime. It should not be taken within 14 days of taking any MAO inhibitor -- drug interactions could be serious and even fatal. It should be prescribed with caution to the elderly or any client with impaired renal or hepatic function. FDA Pregnancy Category: C. The client should consult with her prescriber about planned, suspected, or known pregnancy. The client must consult with prescriber about new or OTC drugs. Drug interactions may occur. Abruptly stopping the drug may cause withdrawal symptoms.

What are common side effects of MAOIs?

MAOIs have a high toxicity. Important: The MAOIs interact with tyramine, which is a chemical found in some foods such as cheese, beer, yeast products, and chocolate. Clients taking MAOIs must avoid such foods. If these kinds of foods and MAOIs are taken concurrently there is a risk of hypertensive crisis. This risk is significant enough that physicians are often reluctant to prescribe MAOIs. Other common side effects include dizziness, vertigo, headache, insomnia, orthostatic hypotension, dry mouth, anorexia, nausea, constipation.

What is Nardil (phenelzine) commonly used for, dosages, and important information?

Nardil (phenelzine) is the most studied MAOI and the most effective one in treating clients with atypical depression. It is also the most sedating one. Like the other MAOIs, it is thought to promote the accumulation of the neurotransmitters epinephrine, norepinehrine, and serotonin by inhibiting their metabolism by the enzyme monoamine oxidase. Dosage Forms: Tablets: 15 mg Adults: 15 mg PO tid May be increased rapidly to 60 mg daily. Maximum dose 90 mg daily which can then generally be reduced to 15 mg daily. Clients must be monitored closely for suicidal tendencies and only given a minimum supply of the drug. Have clients report any signs of a hypertensive crisis: dizziness, headache, nausea, vomiting, neck pain or stiffness. Be sure that clients have a list of foods and drugs that must be avoided.

What is Norpramin (desipramine) commonly used for, dosages, and important information?

Norpramin (desipramine) is used in the treatment of depression. It has also been used to treat bulimea and attention disorder and to help with cocaine withdrawal. Dosage Forms: Tablets: 10, 25, 50, 75, 100, 150 mg Capsules: 25, 50 mg Adults: Initially 50 mg to 150 mg PO in divided doses or the entire dose may be taken at bedtime. Maximum: 300 mg daily Elderly and Adolescents:: Initially 25 mg to 100 mg daily in divided doses. Increased gradually to a maximum dose of 150 mg if needed. As with the other TCAs, Norpramin should not be used concurrently with an MAO inhibitor. It is felt to be especially useful for depressed elderly clients who are sensitive to anticholinergic effect and for individuals with open-angle glaucoma or prostatic hypertrophy. It is frequently prescribed for cardiac clients. This drug may increase a client's sensitivity to the sun. Norpramin may cause dry mouth. Sucking hard candy or chewing gum may help relieve this discomfort. Overdoses of this drug may be fatal. Clients should be monitored for suicidal tendencies or suicidal thoughts and only given a minimal supply of the drug. Safety has not been determined during pregnancy. This drug is not recommended for young children.

What is Pamela (nortriptyline) commonly used for, dosages, and important information?

Pamelor (nortriptyline) is used to relieve the symptoms of depression. Some doctors also prescribe this drug to treat chronic hives, premenstrual depression, attention deficit hyperactivity, and bed wetting. Dosage Forms: Tablets: 10, 25 mg Capsules: 10, 25, 50, 75 mg Oral Solution: 10 mg/5ml Adults: Initially 25 mg tid or qid gradually increasing to 150 mg daily. Entire dose may also be given at bedtime. Serum levels should be monitored when dose is over 100 mg daily. Elderly and Adolescents:: 30 to 50 mg given once daily or in divided doses. As with the other TCAs, Pamelor should not be used concurrently with an MAO inhibitor. It is best taken at bedtime to reduce the risk of dizziness upon standing. Drowsiness and dizziness usually subside after a few weeks. The drug should not be abruptly stopped. Serum levels of this drug can be reliably measured, so it is often used in clients for whom toxicity or compliance is an issue. To prevent sensitivity to the sun, the client should wear sun block, wear protective clothing, and avoid prolonged exposure to the sun. Overdoses may be fatal. Clients should be monitored for suicidal tendencies or suicidal thoughts and only given a minimal supply of the drug. Safety has not been established during pregnancy. This drug is not recommended for young children.

What is Parnate (tranylcypromine) commonly used for, dosages, and important information?

Parnate (tranylcypromine) is the most effective MAOI for the treatment of severe or endogenous depression. A clinical effect may be experienced in about 10 days, which is faster than that achieved with the other MAOIs. Like the other MAOIs, Parnate increases the concentration of the neurotransmitters epinephrine, norepinephrine, and serotonin by preventing their degradation by the enzyme monoamine oxidase. Dosage Forms: Tablets: 10 mg Adults: 10 mg PO tid May be increased by 10 mg daily at 1 to 3 week intervals. Maximum dose 60 mg daily. Parnate is a potent drug which is capable of producing serious side effects. It should be used only for clients who are under close supervision. It can interact with a long list of drugs and foods to produce life-threatening side effects. Be sure that clients have a list of foods and drugs that must be avoided. The most dangerous reaction to Parnate is a surge in blood pressure, which has sometimes been fatal. For this reason, you should tell clients to report promptly to their doctor any of the following symptoms: constriction or pain in the throat or chest, dizziness, fever, headache, irregular heartbeat, light sensitivity, nausea, neck stiffness or soreness, palpitations, pupil dilation, sweating, or vomiting.

What is Paxil (paroxetine) commonly used for, dosages, and important information?

Paxil (paroxetine) is prescribed for major depression, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and more recently for generalized anxiety disorder. The drug is also being tried in the treatment of post-traumatic stress syndrome, premenstrual dysphoria, premature ejaculation, and diabetic neuropathy. It is 13th on the list of the most commonly prescribed drugs in 2002. Dosage Forms: Tablets: 10, 20, 30, 40 mg Controlled Release Tablets: 12.5, 25, 37.5 mg Oral Suspension: 10 mg/5 ml Adults: Initially 20 mg per day, usually in the morning. May be increased in 10 mg/day increments at intervals of at least one week. Extended-release: Initially 12.5 mg daily. Maximum dose: 60 mg/day Elderly: 10 mg daily Maximum: 40 mg/day Paxil should not be taken within 14 days of MAOI therapy. Cautious use for clients with a history of seizures, mania, suicidal tendencies, impaired renal or liver function, cardiac disease, or clients who are volume depleted or on diuretic therapy. Drug should not be stopped abruptly. May result in withdrawal symptoms. Monitor client for sexual dysfunctions. FDA Pregnancy Category: C. May impair reproductive function. Not distributed in breast milk. Safety has not been estalished in children.

What is Pristiq (desvenlafaxine) commonly used for, dosages, and important information?

Pristiq (desvenlafaxine) is a serotonin and norepinephrine reuptake inhibitor indicated for the treatment of major depressive disorder (MDD) in adults. It is currently not approved for use in children under the age of 18. Dosage Forms: Tablets (delayed-release): 50 mg Adults: (for major depressive disorder) With Pristiq, the starting dose is the recommended dose. The recommended dose for Pristiq is 50 mg once daily. When stopping Pristiq, the patient's health care professional may gradually reduce the dose. It should not be stopped without first consulting with the health care professional. Pristiq should be taken at the same time each day. It may be taken with or withour food. The tablets of Pristiq should be swallowed whole with water. They should not be divided, crushed, chewed, or dissolved because the tablets are timed released. This drug should not be used concurrently with a MAOI or within two weeks after an MAOI has been prescribed. Clients should be monitored for significant changes in behavior and for suicidal tendencies. The drug should not be taken by women who are nursing, pregnant, or who plan to become pregnant. The most common side effect is nausea which generally subsides after the first week. Other side effects include dizziness, sweating, constipation, and decreased appetite. Its safety and effectiveness have not been established in children under the age of 18. Clients should be closely monitored for signs of serotonin syndrome which, if severe, can be deadly.

What is Prozac (fluoxetine) commonly used for, dosages, and important information?

Prozac (fluoxetine) is prescribed for major depression and obsessive-compulsive disorder. It is also being used for the treatment of bulimia, other eating disorders, obesity, premenstrual dysphoric disorder, and alcohol dependence. Dosage Forms: Tablets: 10, 20 mg Capsules: (delayed-release) 90 mg Capsules: (pulvules) 10, 20, 40 mg Liquid: 20 mg/5 ml Adults: Initially 20 mg each morning. If no improvement is noted after 2 weeks, dosage may be increased to 80 mg per day in 2 divided doses. Extended-release: Initially 12.5 mg daily. Maximum dose: 60 mg/day Elderly: 10 mg daily. May be increased by 10 - 20 mg every 2 weeks. Maximum: 40 mg/day Children: (8 to 18) Initial dose 5 to 10 mg daily. Increased gradually if needed. Maximum: 40 mg/day Tell client to avoid taking drug in the early afternoon. Commonly causes nervousness and insomnia. Prozac should not be used concurrently with MAO inhibitors. Not to be started within 14 days of MAOI therapy. MAOIs should not be started within 5 weeks of stopping fluoxetine therapy. Used cautiously in clients at high risk for suicide and those with history of diabetes mellitus, seizures, mania, hepatic, renal or cardiovascular disease. Have client consult with prescriber before taking other prescription or OTC drugs. FDA Pregnancy Category: C. Notify prescriber if pregnant or breast feeding. The drug appears in breast milk, so breast feeding is not recommended.

What is Remeron (mirtazapine) commonly used for, dosages, and important information?

Remeron (mirtazapine) is a relatively new antidepressant with a unique structure and mechanism of action. It is thought to enhance noradrenergic and serotonergic activity and adjust the brain's natural chemical balance, especially of norepinephrine and serotonin. Remeron is a superb and unique addition to the antidepressant group of drugs. It may be preferred for clients with SSRI-induced sexual dysfunction, depressed clients with sleep disturbances, poor appetite, or pain, and for depressed clients who are medically ill and taking multiple medications. It does not appear to interfere with the metabolism of other drugs. Dosage Forms: Tablets: 15 mg, 30 mg, 45 mg Tablets (Orally disintegrating): 15 mg, 30 mg, 45 mg Adults: (tablets) 15 mg PO at hour of sleep Maintenance doses: 15 to 45 mg daily. Dosage adjustments: At no less than 1 to 2 weeks. Remeron does not have the common side effects of the TCAs or the SSRIs. It does not have a great potential for interacting with other drugs. It should be taken in the evening before the client goes to bed. It may decrease anxieties and sleep disturbances in as little as 1 to 2 weeks with little effect on libido and a low incidence of gastrointestinal upset. It should not be used concurrently with an MAOI, and clients should not drink alcohol while taking the medication. Its safety and effectiveness has not been established during pregnancy or in children under the age of 18. It is not known whether it appears in breast milk.

What are nursing suicide precautions?

Removing objects that could be used for self-harm from the client's environment. Examples include belts, light cords, razors, glass, knives, nail files, scissors, sharp eating utensils, hard plastic objects, and suspenders. Observing the client carefully during medication administration to be sure that he or she is not hoarding medication to commit suicide. Providing for constant observation. Documenting verbal and non-verbal cues to suicidal thoughts. Use the client's exact words whenever possible. Place these words in quotes to avoid the appearance of bias and to maintain objectivity.

What are common side effects of TCAs?

TCAs are associated with a number of side effects. Anticholinergic effects include dry mouth, blurred vision, constipation, slowed bladder function leading to hesitancy and urinary retention. In addition, the mydriatic action of the tricyclics can precipitate an attack of acute glaucoma. In addition to sleep disturbances, gastrointestinal disturbances, and changes in libido and sexual functioning, high doses of TCAs have been associated with seizures, stroke, and myocardial infarction. The elderly are most susceptible to the side effects, especially orthostatic hypotension which may lead to falls and fall-related injuries. A common CNS effect is sedation which may be beneficial for the client experiencing insomnia. For others, this presents problems such as falling asleep at work or impaired driving. TCAs are best avoided during pregnancy. If used, the ones with low anticholinergic effects are preferred and the drug must be tapered off before delivery.

What are Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) and how do they act in the body?

The SNRIs antidepressants are dual uptake inhibitors that work to relieve the symptoms of depression. The SNRIs increase the levels of both serotonin and norepinephrine by inhibiting their reabsorption into the cells of the brain. The resultant higher levels of these hormones enhance neurotransmission - the sending of nerve impulses - and thus improve and elevate mood.

How do SSRIs act in the body?

The SSRIs inhibit the central nervous system's neuronal reuptake of serotonin and thus increase the concentration of serotonin while in the synapse. This makes more serotonin available for its mood elevating effects. Serotonin is one of the primary chemical messengers (neurotransmitters) in the nervous system and is known to elevate mood. The drug has little effect on the other neurotransmitters, therefore there is less risk of adverse effects

What are some common drug-drug or drug-food interactions with antidepressant drugs?

The TCAs and the MAOIs may cause a hypertensive crisis. There may be added central nervous system (CNS) depression when the antidepressants are combined with other CNS depressants or alcohol. There may be added sympathomimetic and anticholinergic effects when the antidepressants are combined with drugs possessing the same effects. An example is a cold medication containing sympathomimetics and an MAOI. There may be additive hypoglycemia when the MAOIs are used with insulin or the oral hypoglycemic agents. The MAOIs may cause hypertension, coma, convulsions, or death when combined with Demerol (meperidine). Hypertensive episodes may occur when the MAOIs are combined with tyramine-containing foods.

How do TCAs act in the body?

The TCAs prevent the reuptake of norepinephrine, serotonin, or both into the presynaptic nerve endings. This results in increased synaptic concentrations of these neurotransmitters.

What is Wellbutrin (bupropion) commonly used for, dosages, and important information?

The action of Wellbutrin (bupropion) is unknown, but it is thought to be a weak inhibitor of norepinephrine, dopamine, and serotonin reuptake. It is used as a second-line agent in cases of treatment-resistant depression. It also appears to be quite useful in bipolar depression. In addition, it has a low risk for sexual side effects, which may be an important consideration for a client. This drug has the same ingredients as the drug Zyban (bupropion), which is used to aid smoking cessation. Therefore, the two drugs should never be used together. Dosage Forms: Tablets: 75 mg, 100 mg Tablets (extended-release): 100 mg, 150 mg, 200 mg Adults: (tablets) 100 mg PO bid. May be increased after 3 days to 100 mg tid. No single dose should exceed 150 mg. Adults: (extended-release tablets) 150 mg daily in the morning. May be increased to 150 mg bid as early as 4th day of dosing. Maximum dose: 450 mg daily. Although Wellbutrin may cause a weight gain, it more commonly causes weight loss. If weight loss is potentially detrimental to the client, then this drug is not the best choice. The most worrisome side effect is seizures. However, the side effects common with the TCAs are not seen with this drug. Wellbutrin should be avoided in clients with a history of any type of eating disorder or seizure disorder. It should not be used concurrently with a an MAOI -- this may cause a sudden, dangerous rise in blood pressure. It should not be taken concurrently with the drug Zyban, which is another form of the same drug used for smoking cessation. It should not be taken during pregnancy unless it is clearly needed. It also passes into breast milk and may cause serious reactions in a nursing baby. The client will need to chose between breast feeding and continuing the medication.

What is Marplan (isocarboxazid) commonly used for, dosages, and important information?

The mechanism of action of Marplan (isocarboxazid) is not established. It is thought to involve the elevation of brain levels of biogenic amines. Inhibits MAO in the brain, heart and liver. Dosage Forms: Tablets: 10 mg Adults and children > 15 yrs: Initially 10 mg bid. May be increased by 10 mg every 2-4 days to achieve 40 mg/day by the end of the 1st week, if tolerated. Then increase by increments of up to 20 mg/week if needed and tolerated. Max: 60 mg/day. Divide daily dose into 2-4 doses. Not recommended as initial therapy; should be reserved for patients who have not responded satisfactorily to other antidepressants. Clients must be monitored closely for suicidal tendencies and only given a minimum supply of the drug. Caution with hyperactive or agitated patients; may cause excessive stimulation. Avoid alcohol, foods with a high tyramine content (i.e. cheese) and excessive quantities of caffeine.

What is some information on Monoamine Oxidase Inhibitors (MAOIs)?

The monoamine oxidase inhibitors (MAOIs) were the first antidepressants. They were discovered accidentally in the early 1950s as a by-product of research aimed at finding a more effective antituberculosis drug. It was noted that the drug being researched had mood elevation properties -- patients became energized, hyperactive, and sometimes manic. The MAOIs were used extensively until the 1960s when the tricyclics became available. They gradually fell out of favor because of their many drug-drug and drug-food interactions. These drugs may still be prescribed for clients who do not respond to other types of antidepressants. In 2007 the Food and Drug Administration (FDA) approved Abilify (aripiprazole) for use as an additional medication for treatment in adults with major depressive disorder that does not respond to antidepressant therapy. Research indicates that clients who take Abilify in conjunction with antidepressants may experience symptom improvement. The MAOIs are generally prescribed for clients who do not respond to the SSRIs, the TCAs, or the newer atypical/novel agents or for those suffering from atypical depression.

What is some information on SSRIs (Selective Serotonin Reuptake Inhibitors)

The selective serotonin reuptake inhibitors (SSRIs) were introduced in the late 1980s and are safer and better tolerated than the TCAs or the MAOIs. They are popular because they do not cause sedation, hypotension, anticholinergic effects, or cardiac toxicity like the TCAs. The SSRIs are now one of the most commonly prescribed classes of drugs in the US. In addition, they are now being used for many other mental and physical disorders, such as obsessive-compulsive disorders, panic disorders, eating disorders, premenstrual dysphoric disorders, and post-traumatic stress disorders.

What is some information on Tricyclic Antidepressants (TCAs)?

The tricyclics (TCAs) were, at one time, the first choice for the treatment of depression. In the late 1950s, Tofranil (imipramine) was the first one to be marketed. Because of their numerous side effects and the potential for lethal overdose, the TCAs are no longer considered the initial drugs of choice. However, for those that do respond, they are an excellent second choice. The TCAs are mostly used to treat depression. Anafranil has been used in the treatment of obsessive-compulsive disorder, panic disorders, and for chronic pain, and Tofranil has been used in children age 5 and older for childhood enuresis.

How do MAOIs act in the body?

These drugs act by blocking the action of the enzyme, monoamine oxidase, the major enzyme involved in the metabolic degradation and inactivation of norepinephrine, serotonin, and dopamine.

What is Zoloft (sertraline) commonly used for, dosages, and important information?

Zoloft (sertraline) is prescribed for major depression and obsessive-compulsive disorders. It is also used in the treatment of panic disorders, premenstrual dysphoric disorders, and post-traumatic stress disorders. Dosage Forms: Tablets: 25, 50, 100 mg Capsules: 25, 50, 100 mg Oral Concentrate: 20 mg/ml Adults: Initial dose 50 mg daily as a morning or evening dose. May be increased by 50 mg daily at weekly intervals. Maximum dose: 200 mg daily Children: Ages 6 to 12 - 25 mg daily Ages 13 to 17 - 50 mg daily Do not use concurrently with an MAOI. To prevent potential fatal interactions, a washout period of at least 2 weeks is recommended when switching between Zoloft and an MAOI. Can be taken in the morning or evening, with or without food. Client should be monitored for suicidal tendencies and only given a minimal supply of the drug. Client should avoid the use of alcohol and consult prescriber before taking OTC drugs. Should be used cautiously in clients with liver impairment or disease or clients with a history of seizures. FDA Pregnancy Category: C.

What are 6 commonly prescribed SSRIs?

• Celexa (citalopram) • Lexapro (escitalopram) • Luvox (fluvoxamine) • Paxil (paroxetine) • Prozac (fluoxetine) • Zoloft (sertraline)

What are contraindications of SSRIs?

• Hypersensitivity to the drug. • Concurrent use with MAO inhibitors. • Concurrent use of CNS depressants. • Cautious use for clients with impaired renal or hepatic function, history of seizures, mania or hypomania. • Cautious use in children and the elderly. Many have not been well tested for safety in children. • Pregnancy, breast feeding mothers.

When are antidepressant drugs indicated?

the depression is moderate to severe. psychotic, melancholic, or atypical features are present. psychotherapy by trained individuals is not available or has not proven to be beneficial. maintenance treatment is planned and the client has demonstrated a positive prior response to drug therapy. The SSRIs are generally the first choice for clients with mild to moderate depression. The TCAs and MAOIs are reserved for clients with more severe depression. The atypical antidepressants serve as alternatives for clients who do not respond adequately or are unable to tolerate the side effects of the other agents. As stated before, the antidepressants, especially the SSRIs, are also being used for many other emotional problems, such as anxiety disorders, eating disorders, personality disorders, sleep disorders, phobias and for some medical conditions, such as migraine headaches, chronic pain, peptic ulcer disease, and premenstrual dysphoria.