Head of the class
This class of antidepressants is known for selectively blocking the reuptake of serotonin
What are Selective Serotonin Reuptake Inhibitors (SSRIs)?
Many patients starting an SSRI might experience an upset stomach, nausea, or diarrhea. Name 2 things the nurse can do to help with this transient side effect
what are 1) advise to take meds with food, 2) gradual titration 3) adjust timing of medication 4) avoid stopping suddenly
This common anticholinergic side effect of TCAs can make it difficult for patients to see clearly, especially up close.
hat is blurred vision?
This is the most immediate and crucial nursing priority for any hospitalized patient admitted with depression, especially if they have expressed thoughts of self-harm.
What is ensuring patient safety or conducting a suicide risk assessment?
If a patient isn't responding adequately to their current antidepressant, a common initial strategy is to either increase the dose or switch to a different antidepressant. What is this general approach called?
What is optimizing or switching therapy?
While similar to SSRIs, this class of medications also inhibits the reuptake of norepinephrine in addition to serotonin. What antidepressant class targets both of these neurotransmitters?
What are Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?
A common complaint, especially early in treatment, is feeling restless, jittery, or having difficulty falling asleep. Name 2 things the nurse do to help with this
what is 1) discuss adjusting the medication timing2) teach relaxation techniques 3)reduce stimulating activity or food 3) encourage physical activity during the day 4) try to avoid naps/sleeping during the day 4) educate that these are usually transient side effect that will go away as you adjust to med 5) review good sleep hygiene
Patients taking TCAs often experience a dry mouth, constipation, and difficulty urinating. What general category of side effects do these fall under?
What are anticholinergic side effects?
When a depressed patient is withdrawn and isolating, the nurse can use this communication technique, which involves sitting with the patient, making brief empathetic statements, and conveying acceptance.
What is therapeutic presence or active listening?
When a patient has tried one or two antidepressants without full remission, adding a medication from a different class, such as an atypical antipsychotic or lithium, to the existing antidepressant is known by this term.
What is augmentation?
Tricyclic Antidepressants (TCAs) block the reuptake of serotonin and norepinephrine, but their significant side effects are often due to their antagonism at which three other types of receptors?
What are histamine (H1), muscarinic cholinergic, and alpha-1 adrenergic receptors?
While generally well-tolerated, SSRIs can sometimes lead to a condition characterized by excessive sweating, especially at night. What is this common autonomic side effect?
What is diaphoresis (or excessive sweating)?
A critical dietary restriction for patients on MAOIs involves avoiding foods high in this substance, which can lead to a hypertensive crisis. What is this substance?
What is tyramine?
For a patient experiencing severe psychomotor retardation due to depression, the nurse's primary role in activities of daily living (ADLs) often involves providing this type of assistance.
What is gentle encouragement and direct assistance with hygiene, nutrition, and hydration?
This non-invasive brain stimulation therapy involves using magnetic fields to stimulate nerve cells in the brain, and it's often considered for major depressive disorder when medication trials have been unsuccessful.
What is Transcranial Magnetic Stimulation (TMS)?
This older class of antidepressants works by inhibiting an enzyme that metabolizes monoamine neurotransmitters like serotonin, norepinephrine, and dopamine. What is the name of the enzyme they inhibit?
What is monoamine oxidase (MAO)?
A patient is prescribed an SSRI like sertraline, and they begin to have more sleepless nights, they call the clinic stating they have not slept in 4 days & feel restless, you try to ask more questions but the patient will not stop talking
What is mania or hypo mania
TCAs carry a significant risk of cardiac toxicity, especially in overdose. What specific cardiovascular effect are nurses most concerned about monitoring, often seen as changes on an ECG?
What are arrhythmias or QT prolongation?
Before a depressed patient is discharged, the nurse collaborates with the interdisciplinary team to develop this comprehensive plan, which includes follow-up appointments, medication management, and identifying personal coping strategies and crisis resources.
What is a comprehensive discharge plan or a safety plan?
Beyond atypical antipsychotics, two other classes of medications sometimes used to augment antidepressant therapy include mood stabilizers like lithium and certain hormones. Name one of these other classes.
What are mood stabilizers (e.g., lithium) or thyroid hormones (e.g., liothyronine)?
Mirtazapine, an atypical antidepressant, has a unique mechanism. Instead of reuptake inhibition, it primarily works by blocking presynaptic alpha-2 adrenergic autoreceptors and postsynaptic serotonin 5-HT2 and 5-HT3 receptors. What is the effect of blocking these alpha-2 autoreceptors?
hat is increased release of norepinephrine and serotonin?
When discontinuing an SSRI too quickly, patients might experience symptoms like dizziness, "brain zaps," or flu-like symptoms. What is this phenomenon commonly called?
What is antidepressant discontinuation syndrome (or withdrawal symptoms)?
Beyond dietary restrictions, MAOIs have a serious interaction with many other medications, particularly those that increase serotonin. What potentially life-threatening syndrome can result from such an interaction?
What is serotonin syndrome?
If a depressed patient is starting an antidepressant, the nurse must educate them and their family about the potential for increased energy and motivation before a significant improvement in mood, which can temporarily elevate this specific risk.
What is the risk of increased suicidal ideation or acting on suicidal thoughts?
For severe, treatment-resistant depression, especially when accompanied by psychotic features, suicidality, or catatonia, this highly effective brain stimulation therapy involves inducing a brief, controlled seizure under general anesthesia.
What is Electroconvulsive Therapy (ECT)?