Summary of ANTIDEPRESSANTS Overview (SSRIs, MAOIs, TCAs) | Nursing Pharmacology | NurseInTheMaking

Summary of Video on Antidepressants

Main Ideas:

• Overview of antidepressants commonly tested in nursing school: SSRIs, TCAs, and MAOIs.
• Importance of understanding the risks associated with antidepressants, especially the increased risk of suicide when starting treatment.
• Need for gradual tapering of medications rather than abrupt cessation.

Key Concepts:

1. General Risks of Antidepressants:
   • All antidepressants may increase the risk of suicide, particularly when energy levels rise before mood improves.
   • Patients should not stop taking these medications abruptly; a tapering schedule is necessary.
2. SSRIs (Selective Serotonin Reuptake Inhibitors):
   • Uses: Depression, anxiety, OCD, eating disorders.
   • Mechanism: Inhibit serotonin reuptake, increasing serotonin levels in the brain.
   • Suffixes to Remember: -talopram, -oxitine, -zodone (with sertraline as an outlier).
   • Common Side Effects: Sexual dysfunction, gastrointestinal upset, weight gain, and serotonin syndrome (characterized by muscle rigidity, restlessness, high heart rate, and mental changes).
   • Patient Education:
     • Takes 4-6 weeks to see effects; compliance is crucial.
     • Should be taken in the morning (memory trick: "take at sunrise").
     • Avoid combining with MAOIs or St. John's Wort due to risk of serotonin syndrome.
3. TCAs (Tricyclic Antidepressants):
   • Uses: Depressive episodes, bipolar disorder, OCD, neuropathy.
   • Mechanism: Block reuptake of serotonin and norepinephrine.
   • Suffixes to Remember: -triptyline, -pramine (with amoxapine as an outlier).
   • Common Side Effects: Dizziness, orthostatic hypotension, anticholinergic effects (urinary retention, blurred vision, dry mouth, constipation).
   • Patient Education:
     • Wait 14 days after stopping MAOIs before starting TCAs.
     • Rise slowly to prevent falls due to orthostatic hypotension.
     • Increase fluids and fiber to combat constipation (memory trick: "fluids and fiber fill the toilet").
4. MAOIs (Monoamine Oxidase Inhibitors):
   • Uses: Depression.
   • Mechanism: Inhibit monoamine oxidase, increasing epinephrine, norepinephrine, dopamine, and serotonin levels.
   • Medications to Remember: Tranylcypromine, Isocarboxazid, Phenelzine (spelling out "TIP").
   • Patient Education:
     • Wait 14 days after stopping SSRIs or TCAs before starting MAOIs.
     • Follow a tyramine-restricted diet to avoid hypertensive crises (high-tyramine foods include aged cheese, fermented meats, and overripe fruits).
     • Should be taken in the morning to avoid sleep disturbances (memory trick: "MAOIs think morning").
     • Takes 4 weeks to reach therapeutic effects.

Methodology/Instructions:

• Monitoring for Suicide Risk:
  • Assess for suicidal thoughts, especially when a patient expresses increased energy.
• Patient Education:
  • Educate patients about the time required for medications to take effect.
  • Discuss dietary restrictions for MAOIs.
  • Emphasize the importance of not stopping medications abruptly and the need for gradual tapering.

Speakers/Sources:

• Christine from NurseInTheMaking.

Notable Quotes

— 00:50 — « All antidepressants increase the risk for suicide. »

— 03:09 — « Just like any medication which is meant for good, it ends up doing more harm because it's excreting its effect too much. »

— 05:51 — « Can't pee, can't see, can't spit, and can't poop. »

— 06:51 — « Fluids and fiber fill the toilet. »

— 08:23 — « You need to follow a tyramine-restricted diet while being on MAOIs. »

Category

Educational

Video