Mental Health PharmacologyAntidepresssantsPrescription drugs used to treat depression and a variety of other psychological conditions such as anxiety, panic, posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). Antidepressant medications are classified into four main groups. The different categories of antidepressants differ in terms of the neurotransmitters affected and the process involved in increasing these neurotransmitters. Antidepressants (2-8 weeks to be effective= Suicide watch)Four GroupsTricyclic Antidepressants (TCAs)Selective Serotonin Reuptake Inhibitors (SSRIs)Monoamine Oxidase Inhibitors (MAOIs)Atypical Antidepressants1.Tricyclic Antidepressants (TCA)-(e.g.amitriptyline, Elavil,) increase Serotonin and Norepinephrine by also blocking the reuptake process (the removal of these neurotransmitters). Because of more adverse side effects, TCAs are prescribed less often than SSRIs. Monitor for side effects: Cardiac toxicity*arrhythmias, orthostatic hypotension, anticholinergic (dry mouth, etc.), sedation,weight gain. Avoid concurrent use of TCAs with MAOIs, antihistamines, alcohol, benzodiazepines, opioids. High risk for lethality with overdose. 2.Selective Serotonin Reuptake Inhibitors(SSRI)- (e.g. fluoxetine, Prozac)most commonly prescribed antidepressants also used for OCD, bulimia, and PTSD. SSRIs increase the amount of Serotonin, enhancing feelings of well-being and happiness. Inform client to take medication as prescribed; abrupt discontinuation of drug is contraindicated. Monitor for: weight gain, sexual dysfunction, suicidal tendencies, orthostatic hypotension, serotonin syndrome. Avoid concurrent use with MAOIs, TCAs, warfarin, NSAIDs.3.Monoamine Oxidase Inhibitors (MAOI)- (e.g. phenalzine, Nardil)inhibit the action of an enzyme called monoamine oxidase, increases the amounts of dopamine, serotonin and norepinephrine, relieves depression. MAOIs are less prescribed than SSRIs and TCAs because of possible severe side effect of hypertensive crisisand drug interactions.Safety: fatal food and drug interaction must understand a tyramine-restricted diet(aged cheese, alcohol, cured meats (corned beef, salami, ham) and fish, avocado, beer, red wine). Avoid concurrent use with TCAs, SSRIs.4.Atypical antidepressants:- (e.g. bupropion,Wellbutrin) do not fall into any of the above categories, they affect a different combination of neurotransmitters. Alternative to SSRIs if pt has sexual dysfunction, aid to quit smoking. Monitor for: wt. loss, seizures (high doses). Avoid concurrent use of MAOIs- do not take within 14 daysof stopping MAOI. SSRI’SAtypicalTCA’SMAOIsFluoxetine (Prozac)Bupropion (Wellbutrin)Amitriptyline (Elavil)Phenelzine (Nardil)Escitalopram (Lexapro)Trazodone (Desyrel)Clomipramine (Anafranil)Tranycypromine (Parnate)Citalopram (Celexa)Nefazodone (Serzone)Doxepin (Sinequan)Fluvoxamine (Luvox)Venlafaxine (Effexor)Nortiptyline (Pamelor)
