Antidepressant Mental Health Nursing Unit V

1. Presented by:
Mr. P. Vethadhas M.Sc (N),
Assistant Professor,
Dept.of Mental Health Nursing.

2. ANTIDEPRESSANTS
Antidepressants are those drugs, which are used for the
treatment of depressive illness. These are also called as mood
elevators or thymoleptics.

3. Indications

4. Depression
Depressive episode
Dysthymia
Reactive depression
Secondary depression
Abnormal grief reaction

5. Childhood psychiatric disorders
Enuresis
Separation anxiety disorder
Somnambulism
School phobia
Night terrors

6. Other psychiatric disorders
Panic attack
Generalized anxiety disorder
Agoraphobia, social phobia
OCD with or without depression
Eating disorder
Borderline personality disorder
Post-traumatic stress disorder
Depersonalization syndrome

7. Medical disorders
Chronic pain
Migraine
Peptic ulcer disease

8. Pharmacokinetics
Antidepressants are highly lipophilic and protein-bound.The
half-life is long and usually more than 24 hours. It is predominantly
metabolized in the liver.

9. Mechanism of Action
• The exact mechanism is unknown. The predominant action is by
increasing catecholamine levels in the brain.
• TCAs are also called as Mono Amine Reuptake Inhibitors (MARls).
The main mode of action is by blocking the reuptake of norepinephrine
(NE) and/ or serotonin (5-HT)at the nerve terminals, thus increasing
the NE and 5-HTlevels at the receptor site.

10. Mechanism of Action
• MAOIs instead act on MAO (monoamineoxidase),which is responsible
for the degradation of catecholamines after re-uptake. The final effect
is the same, a functional increase in the NE and 5-HT levels at the
receptor site. The increase in brain amine levels is probably responsible
for the antidepressant action. It takes about 5 to 10days for MAOIs and
2 to 3 weeks for TCAs to bring down depressive symptoms.
• SSRIs act by inhibiting the re-uptake of serotonin and increasing its
levels at the receptor site.

11. Side Effects

12. 1. Autonomic side-effects:
Dry mouth
Constipation
Cydoplegia
Mydriasis
Urinary retention
Orthostatic hypotension
Impotence, impaired ejaculation
Delirium and aggravation of glaucoma.

13. 2. CNS effects:
Sedation
Tremor and other extrapyramidal symptoms,
Withdrawal syndrome
Seizures
Jitteriness syndrome
Precipitation of mania.

14. 3. Cardiac side-effects:
Tachycardia,
ECG changes,
Arrhythmias,
Direct myocardial depression,
Quinidine-like action (decreased conduction time).

15. 4. Allergic side-effects:
Agranulocytosis
Cholestatic jaundice
Skin rashes
Systemic vasculitis

16. 5. Metabolic and endocrine side-effects:
Weight gain

17. 6. Special effects of MAOI drugs:
Hypertensive crises,
Severe hepatic necrosis,
Hyperpyrexia.

18. Nurse's Responsibility for a Patient
Receiving Antidepressants
• Most of the nurse's responsibilities for a patient on antidepressants are
the same as for a patient receiving antipsychotics . In addition:
• Patients on MAOIs should be warned against the danger of ingesting
tyramine-rich foods which can result in hypertensive crisis.
• Some of these foods are beef liver, chicken liver, fermented sausages,
dried fish, over riped fruits, chocolate and beverages like wine, beer
and coffee.

19. Cont..,
• Report promptly if occipital headache, nausea, vomiting, chest pain or
other unusual symptoms occur ; these can herald the onset of
hypertensive crisis.
• Instruct the patient not to take any medication without prescription.
• Caution the patient to change his position slowly to minimize
orthostatic hypotension.
• Strict monitoring of vitals, especially blood pressure is essential.