SSRI Basics
A patient started taking sertraline 8 days ago for depression. The patient reports mild nausea and says, “This medicine isn't working.” What is the nurse's best response?
“It can take several weeks to feel the full effects, and mild nausea can occur.”
Rationale: SSRIs can take several weeks to start working fully. Nausea is a common side effect, but the patient should report it if it gets worse.
A nurse is explaining how SSRIs help treat depression. Which statement best describes how these medications work?
They block serotonin reuptake, making more serotonin available.
Rationale: SSRIs block serotonin reuptake, which makes more serotonin available in the brain. This helps treat depression and anxiety.
A patient taking paroxetine reports sexual dysfunction and feels embarrassed discussing it. What is the nurse's best response?
Encourage the patient to discuss the symptom with the provider because it can occur with SSRIs.
Rationale: Sexual dysfunction is a common side effect of SSRIs. The nurse should let the patient know this can happen and encourage them to talk to the provider about it.
A 22-year-old patient recently started an SSRI and reports worsening hopelessness and thoughts of suicide. What should the nurse do first?
Assess suicidal intent, plan, access to means, and immediate safety.
Rationale: New or worsening suicidal thoughts need to be taken seriously. The nurse should ask about the patient's plan and access to anything they could use to hurt themselves and make sure they are safe.
A patient is starting an SSRI. Which symptoms or situations should the patient report to the provider? Select all that apply.
A. New or worsening suicidal thoughts
B. Mild nausea during the first few days
C. Starting St. John's wort
D. Feeling much better after one week
E. Agitation, fever, and muscle jerking
A, C, E
Rationale: Suicidal thoughts, medication interactions, and symptoms of serotonin syndrome need to be reported. Mild nausea can be a common side effect, and SSRIs usually take several weeks to fully work.
During an assessment before starting an SSRI, a patient reports having periods of very little sleep, unusually high energy, and risky behavior. What should the nurse do?
Report the history to the prescriber for further evaluation.
Rationale: These symptoms could be signs of bipolar disorder. The nurse should report this to the provider because SSRIs can trigger mania in some patients.
A patient taking sertraline says they have been using an over-the-counter cough medicine containing dextromethorphan. What should the nurse do?
Check the medication and contact the pharmacist or provider about the interaction.
Rationale: Dextromethorphan can interact with sertraline and increase the risk of serotonin syndrome. The nurse should check the medication and contact the pharmacist or provider.
A patient taking an SSRI develops a fever, agitation, heavy sweating, and muscle stiffness. What serious reaction should the nurse suspect?
Serotonin syndrome.
Rationale: These symptoms could mean serotonin syndrome, which can be life-threatening. The nurse should get help right away.
A patient taking an SSRI tells the nurse they started taking St. John's wort to help with their depression. What should the nurse do?
Tell the patient that it can interact with their SSRI and notify the provider.
Rationale: St. John's wort can increase serotonin levels when taken with an SSRI. This can cause serotonin syndrome, so the patient should talk to their provider before using it.
A nurse is reviewing the medication histories of four patients taking SSRIs. Which patient is at the greatest risk for a life-threatening complication?
A. A patient taking sertraline who reports nausea, decreased appetite, and difficulty sleeping during the first week of treatment.
B. A patient who stopped fluoxetine 3 days ago and is scheduled to begin an MAOI today.
C. A patient taking escitalopram who reports headaches, sweating, and trouble sleeping since starting treatment.
D. A patient taking paroxetine who reports sexual dysfunction and wants to discontinue the medication.
B
Rationale: Fluoxetine stays in the body for a long time. Starting an MAOI too soon after stopping fluoxetine can cause life-threatening serotonin syndrome, so a longer waiting period is needed.
A patient taking fluoxetine reports feeling better and wants to stop taking it today. What is the nurse's best response?
“Talk with your prescriber before stopping or changing your medication.”
Rationale: The patient should not stop taking the medication just because they feel better. They should talk to the provider before stopping or changing the dose.
A patient taking an SSRI is prescribed phenelzine, an MAOI. What should the nurse do?
Clarify the prescriptions with the provider before giving the medications together.
Rationale: SSRIs should not be combined with MAOIs because the combination can cause life-threatening serotonin syndrome. A safe waiting period is required when switching between these medications.
A patient taking an SSRI develops agitation, sweating, and diarrhea. What serious side effect should the nurse suspect, and what is a muscle-related sign the patient might have?
1. Serotonin syndrome
2. Clonus (repeated muscle jerking) or hyperreflexia (overactive reflexes).
Rationale: SSRIs can cause serotonin syndrome, especially when taken with other medications that increase serotonin. Clonus and hyperreflexia are warning signs that the patient may be having this serious reaction.
A patient with depression started taking fluoxetine 2 weeks ago. The patient reports sleeping only 3 hours a night, having racing thoughts, talking much faster than usual, and spending large amounts of money impulsively. What should the nurse suspect?
Suspect possible mania
Rationale: These symptoms could mean the antidepressant is triggering mania, especially if the patient has bipolar disorder and hasn't been diagnosed.
A patient with depression is prescribed an SSRI. Which explanation best describes how this medication helps improve symptoms?
A. It prevents serotonin from being released into the synaptic cleft, reducing stimulation of serotonin receptors.
B. It blocks the reuptake of serotonin into the presynaptic neuron, leaving more serotonin available in the synaptic cleft.
C. It increases the breakdown of serotonin, allowing the brain to regulate mood more effectively.
D. It blocks serotonin receptors, preventing excessive serotonin activity in the brain.
B
Rationale: SSRIs block serotonin reuptake, leaving more serotonin available in the synapse. It takes several weeks for the full therapeutic effects to develop.