Antidepressants

1. MHN presentation
Saad Ur Rahman Mazhar Ullah Muhammad Ismail
Mental Health Nursing
BSN 6th semester
30 Oct, 2023

2. By the end of this presentation the learner will be able to:
 classify antidepressants.
 Discuss the mechanism of action of various antidepressants.
 Identify the side effects and adverse effects of antidepressants.
 Discuss their nursing interventions.

3. First Generation antidepressants
1. Monoamine Oxidize Inhibitors (MAOIs)
2. Tricyclic Antidepressants
Second generation antidepressants
1. Selective Serotonin Uptake Inhibitors (SSRIs)
2. Norepinephrine Reuptake Inhibitors (NARIs or SNRIs)
3. Miscellaneous drugs
Mood stabilizers

4.  Mood is controlled by the level of Monoamine (biogenic amine) activity in the
brain. (Serotonin, Norepinephrine and Dopamine)
 Psychomotor stimulants like cocaine improve mood and drugs like reserpine
that block monoamines cause depression.
 All antidepressant drugs increase serotonin activity, this is a necessary, but
not sufficient effect to act as an antidepressant. Mood is clearly a result of a
complex interaction between all monoamines and other neurotransmitters.

5. Monoamine Oxidase Inhibitors(MAOIs)
 MAOIs block Monoamine oxidase (MAO). MAO inactivates the
neurotransmitters (Epinephrine, nor-epinephrine, serotonin). When
MAO is inhibited the amount of neurotransmitter is increase in
brain, which results in reduction in depression.

6.  Ipronazid (no longer used)
 Phenelzine (Nardil),
 Tranylcypromine (Parnate),
 Moclobemide (Ludiomil
 Selegine

7.  Can be used for any type of depression
 Clinically useful for atypical depression.
 With interaction tyramine containing substances (Cheese) it causes
hypertensive crisis. So, due this life-threatening effect MOAIs are
considered second-line agent for the treatment of depression

8.  Lowers blood pressure – postural hypotension
 Block metabolism of other all biogenic amines and therefore
increse the effect of any drug that increases biogenic amine
levels such as psychomotor stimulants, decongestants, nose
drops, etc
 Also potentates alcohol and opioids.
 Blocks metabolism of tyramine found in aged cheese, pickled
herring, beer wine, chocolate. Accumulation of tyramine causes
high blood pressure causes internal bleeding, stroke.

9.  These are drug agents that have a tricyclic chemical structure.
Although they are different structurally, they are similar
pharmacologically and therapeutically.
 Tricyclics block reuptake of MAs, but newer TCAs have other
effects as well.
 Inhibition or Reuptake of Mono amines results in the increased
accumulation of these neurotransmitter in the brain, which
causes a reduction in depression.

10.  Amitriptyline (Elavil, tryptanol)
 Desipramine (Norpramin)
 Nortriptyline (Aventyl)
 Doxepin (Adapin)
 Mirtazapine (Remeron)

11.  is a tricyclic antidepressant commonly used to treat depression and various chronic pain
conditions. It works by increasing the levels of certain neurotransmitters in the brain. Common side
effects include drowsiness, dry mouth, and constipation.
is a tetracyclic antidepressant primarily used to treat depression and schizophrenia. It helps
restore the balance of certain chemicals in the brain. Side effects may include dizziness,
drowsiness, and blurred vision
is a tricyclic antidepressant used to treat depression and attention deficit hyperactivity
disorder (ADHD). It works by affecting the balance of certain natural chemicals in the
brain. Common side effects include dry mouth, constipation, and blurred vision

12. is a tricyclic antidepressant prescribed for depression, anxiety, and insomnia. It helps restore the
balance of certain neurotransmitters in the brain. Side effects may include drowsiness, dry mouth,
and blurred vision.
Doxepin
is a tricyclic antidepressant commonly used to treat depression and bedwetting in children. It works by
increasing the levels of certain chemicals in the brain. Side effects may include dizziness, dry mouth,
and constipation
Imipramine
is a tricyclic antidepressant prescribed for depression and certain chronic pain conditions. It helps
restore the balance of certain neurotransmitters in the brain. Common side effects include dry
mouth, drowsiness, and constipation
Nortriptyline

13. •Amitriptyline, doxepin, imipramine and trimipramine:
are more likely to make you sleepy than other tricyclic
antidepressants are. Taking these medications at bedtime may help.
•Amitriptyline, doxepin, imipramine and trimipramine:
are more likely to cause weight gain than other
tricyclic antidepressants are.
•Nortriptyline and desipramine:
appear to have better tolerated side effects than other tricyclic
antidepressants do.

14.  TCAs are used to treat depression.
 They have been used for over 40 years.
 They are less expensive than other antidepressants.
 TCAs are also used in the treatment of facial neuralgia.
 Their anti-cholinergic properties results in many adverse-
effects, and unfortunately, reduces their use.

15.  Anti-Cholinergic activity, which include:
 Dizziness
 Postural hypotension
 Constipation
 Dry mouth
 Edema
 Muscle tremor/pain
 Delayed unrination

16.  Second generation antidepressants are a group of new
antidepressants drugs that are generally considered superior to
TCAs in terms of their less side-effects but not of their overall
efficacy or onset of action.
 Selective Serotonin Reuptake Inhibitors (SSRIs) are second
generation antidepressants.
 SSRIs act as antidepressant by selectively inhibition serotonin reuptake
while having little or no effect on non-epinephrine or dopamine
reuptake.
 When serotonin is inhibited from reuptake, its amount increases in the
synaptic cleft, which decreases depression.

17.  Fluoxetine (Prozac, Flux, Depricap)
 Fluvoxamine (Luvox)
 Sertraline (Zoloft)
 Paroxetine (Paxil)
 Citalopram (Celexa).

18.  SSRIs are used to treat many affective disorders. These drugs can be
effectively used to treat depression, bipolar affective disorders, obesity,
eating disorders, OCD, panic attack, and social anxiety disorders.
 SSRIs have less side effects as compare to TCAs or MOAIs. The
common side effects may be:
 Headache, dizziness, tremor, nervousness, insomnia fatigue
 Nausea, diarrhea, constipation, dry mouth
 Sweating and sexual disorders

19.  Mode of action:
 Selectively inhibits the re-uptake of serotonin and
norepinephrine.
 SNRIs may be effective in treating depression in patients in
whom chronic painful symptoms, such as backache and
muscle aches against which SSRIs are also ineffective.
 Side effects:
 Nausea, headache, sexual dysfunction, dizziness, insomnia,
constipation, sweating and somnolence.

20. Examples are:
Venlafaxine
Duloxetine

21.  Nursing Responsibilities
 Before Administration
 Check for drug or herbal interactions
 Check for allergies
 Assess baseline mental status
 Assess for suicidal tendencies

22.  After Administration
 Monitor for effectiveness as exhibited by a decrease in symptoms
 Monitor for side effects and serotonin syndrome
 Remember that a lot of these drugs can cause dizziness in the
first few weeks of taking so take safety precautions

23.  Insure the patient takes the medication as prescribed. The medication should
not be withdrawn abruptly but tapered. If withdrawn abruptly can cause:
 Dizziness, headache, nausea, tremor, anxiety and mood changes
 Symptoms can occur within a day of stopping or up until weeks of ending and
the symptoms can persist for weeks
 These drugs may take 3-4 weeks or longer to be effective.
 Inform of drugs and herbs that can interact
 SSRIs work best for moderate to severe depression when accompanied by
some type of psychotherapy

24.  CDC (2011)
 Cushing, T. MD, MPH, (2011) SSRI Toxicity, Medscape
 Lehne, Richard (2010) Pharmacology for Nursing Care 7th ed. Elsevier,
Saunders. St. Louis, Missouri
 Mayo Clinic SSRI (2011)
 Workman, Linda et al.(2011) Understanding Pharmacology: Essentials for
Medication