Anti-depressant ggggghhhhhhhhhhhhhhhhhhh

Health care

1. Anti-depressant drugs Under Supervision Dr. Aya Abd Elazeim Dr. Nora Naser 6 th Term

2. Outlines : Introduction of anti-depressant drugs. Indications of anti-depressants drugs. Classifications of anti-depressants drugs: Tricyclic anti-depressants drugs (TCAs). Monoamine oxidase inhibitors anti- depressants drugs (MAOIs). Selective serotonin reuptake inhibitors (SSRIs). Serotonin-norepinephrine reuptake inhibitors (SNRIs). Norepinephrine and dopamine reuptake inhibitors (NDRIs). Nursing intervention for side effects of anti-depressant drugs. Health education for patients taking Anti-depressant drugs.

3. Introduction of anti-depressants drugs: Antidepressants are a class of drugs that reduce symptoms of depressive disorders by correcting chemical imbalances of neurotransmitters in the brain. Chemical imbalances may be responsible for changes in mood and behavior.

4. Indications of anti-depressants drugs. Psychiatric Uses: 1. Major Depressive Disorder (MDD) 2. Generalized Anxiety Disorder (GAD) 3. Obsessive-Compulsive Disorder (OCD) 4. Panic Disorder (PD) 5. Post-Traumatic Stress Disorder (PTSD) 6. Social Anxiety Disorder. 7. Bipolar Disorder. 8. Eating Disorders (e.g., Anorexia Nervosa, Bulimia Nervosa) 9. Sleep Disorders (e.g., Chronic Insomnia) – Certain antidepressants like TCA. 10. Premenstrual Dysphoric Disorder (PMDD) – SSRIs are commonly used. 11. Menopausal Symptoms – SSRIs and SNRIs can reduce hot flashes.

5. Major types of antidepressant drugs   1.Tricyclic anti-depressants drugs (TCAs).   2.Monoamine oxidase inhibitors anti- depressants drugs (MAOIs). 3. Selective serotonin reuptake inhibitors (SSRIs). 4. Serotonin-norepinephrine reuptake inhibitors (SNRIs). 5. Norepinephrine and dopamine reuptake inhibitors (NDRIs).

6. Tricyclic antidepressants drugs (TCAs) A-Pharmacodynamics: TCAs block reuptake of norepinephrine, serotonin and dopamine. Where they increase in synapse in order to enhance the mood and relive depression on the other hand. *N.B The TCAs may take 4 to 6 weeks to be effective. B- Pharmacokinetics: TCAs are absorbed in the GIT Distributed within blood Metabolized in liver Excreted by kidney (Urine) Common generic and trade name of TCAs: Generic name Trade name Imipramine Tofranil Clomipramine Anafronil Amitriptyline Elavil

7. 2. Monoamine Oxidase Inhibitor A. Pharmacodynamics - MAOIs are responsible for breaking down neurotransmitters (dopamine, norepinephrine and serotonin) in the brain. - Low level of these three neurotransmitters has been associated with depression and anxiety. - MAOIs inhibit the breakdown of these three neurotransmitters from the brain by blocking the effects of monoamine oxidase enzymes, result in increasing the concentration of these neurotransmitters and relieving symptoms associated with depression such as sadness or anxiety

8. N.B Approximately 2 to 4 weeks is required for the antidepressant effect of MAOIs to occur B . Pharmacokinetics Readily absorbed from GIT and metabolized in liver and excreted rapidly in the urine Distributed within blood Antidepressant effects require at least 2 to 4 weeks of treatment Common generic and trade name of MAOIs: Generic name Trade name Isocarboxazid Marplan Phenelzine Nardil Tranylcypromine Parnate

9. Selective serotonin reuptake inhibitors (SSRIs): A: Pharmacodynamics (the effect of drugs on body):   Serotonin is one of neurotransmitters that have been synthesis in the vesicles in presynaptic and responsible to regulate the mood and reduce depression. SSRIs help makes serotonin more available by blocking the reabsorption of serotonin in presynaptic to post synaptic through synapsis to make its action and regulate the mood. They have fewer side effects than TCAS and less danger than MOAIs, So they consider as first line for treatment of depression. N.B SSRIs may be effective in 2-3 weeks B: Pharmacokinetics (the effect of body on drugs): SSRIs are absorbed in the GIT. Distributed within blood. Metabolized in liver. Excreted by kidney (Urine).

10. Common generic and trade name of SSRIs: Generic name Trade name Citalopram Celexa Escitalopram Lexapro Fluoxetine Prozac, Serafem , Symbyax Sertraline Zoloft

11. 4. Serotonin-norepinephrine reuptake inhibitors (SNRIs):- A: Pharmacodynamics: SNRIs block the reabsorption (reuptake) of the neurotransmitters serotonin and norepinephrine in the brain leading to increase serotonin and noradrenaline in the synaptic cleft and subsequent the concentration returns to within the normal range.

12. SNRIs are absorbed in the GIT then distributed within blood and finally Metabolized in liver and excreted by kidney (Urine). Common generic and trade name of SNRIs Generic name Trade name Desvenlafaxine pristiq, Duloxetine Cymbalta, Irenka Venlafaxine EfexorXR

13. 5. Norepinephrine and dopamine reuptake inhibitors (NDRIs): A: Pharmacodynamics :   The NDRTs block the reuptake of both Norepinephrine and dopamine this in turn leads to increase extracellular concentration of both Norepinephrine and dopamine leading to regulate mood and alleviate depression.

14. B : Pharmacokinetics:   NDRIs is absorbed in the GIT, distrusted in blood, metabolized in liver, and excreted Common drugs of NDRIs: Bupropion (Wellbutrin): is the only drug in this category and is unique in two ways.

15. Nursing intervention for anti-depressant side effects: Dry mouth Offer the client sugarless candy, ice, frequent sips of water. Strict oral hygiene is very important. Blurred vision Offer reassurance that this symptom should subside after a few weeks. Instruct the client not to drive until vision is clear. Clear small items from routine pathways to prevent falls. Constipation Order foods high in fiber; increase fluid intake Encourage the client to increase physical exercise, if possible Sedation (TCA) in the first week occurs because of histamine H 1 antagonism Request an order from the physician for the drug to be given at bedtime. Request that the physician decrease the dosage or perhaps order a less sedation drug. Instruct the client not to drive or use dangerous equipment while experiencing sedation. Urinary retention Instruct the client to report hesitancy or inability to urinate. Monitor intake and output. Try various methods to stimulate urination, such as running water in the bathroom or pouring water over the perennial area.

16. Orthostatic hypotension             Suicide Instruct the client to rise slowly from a lying or sitting position. Monitor blood pressure (lying and standing) frequently, and document and report significant changes. Carefully monitor blood pressure and pulse rate and rhythm, and any significant change Anti-depressant drugs can energize patients who have been too depressed to act on their suicidal thoughts. Therefore, depressed patients who are suicidal warrant special nursing consideration after anti-depressant therapy has been initiated. The TCAs may take 4to 6 weeks to be effective.             Tyramine reaction (MAOIs) Hypertensive crisis: it is a sever increase in blood pressure that may occur when there is excess level of tyramine in the blood. Sings and symptoms: Sever chest pain, Nausea , vomiting, Sever anxiety, Sever headache accompanied by confusion and blurred vision , Fever, Shortness of breathing, Seizures, Marked increase in blood pressure, Palpations, Flushing and sweating Management : Stop intake of MAOIs Admit the patient to ICU (EMERGENCY SITUATION) Rapid reduction of BP Remaining calm and using a benzodiazepine, which will lower BP safely significant and sufficient extent Observation and BP monitoring Monitor vital signs and Use external cooling measures to control hyperpyrexia Administer short-acting antihypertensive drugs , as ordered by physician      

17. Serotonin syndrome: (SSRIs)   is a life-threatening condition caused by excessive serotonergic activity in the central nervous system (CNS), often due to the use of serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs, triptans , or recreational drugs like MDMA). It requires prompt recognition and management. Signs and symptoms   Management of Serotonin Syndrome Immediate Actions Discontinue all serotonergic drugs. Provide supportive care, including IV fluids and monitoring of vital signs. Antidote: triactin Symptom Control: Agitation: Use benzodiazepines (e.g., lorazepam or diazepam) to reduce agitation, muscle rigidity, and hyperthermia.

18. Hyperthermia: Use cooling blankets or antipyretics. Monitoring: Monitor for complications such as rhabdomyolysis, renal failure, disseminated intravascular coagulation (DIC), or seizures. Check creatine kinase (CK) levels, renal function, and coagulation profiles. Severe Cases: For severe cases with life-threatening symptoms (e.g., hyperthermia, rigidity, or autonomic instability), consider intubation, mechanical ventilation, and admission to the ICU. If cyproheptadine is ineffective, consult a toxicologist for further guidance. Prevention: Avoid combining serotonergic drugs. Educate patients about the risks of serotonin syndrome, especially when starting or changing medications. So, in these case we can recommended DNRIs ( wellinta sr ) as Anti-depressant only and some of anti- convalsunt as mood stabliziers If triactin as cyproheptadine not effective, we will use pk. Merz , Danterelax for rigidity    

19. Health education for patients taking Anti-depressant drugs. Instruct patient not stop taking antidepressants drugs alone without consulting the doctor. Instruct patient not to mixed antidepressant drugs and other drug without consulting the doctor because some drugs although safe when taken alone can cause severe and dangerous side effects if taken with other drugs Instruct patient to tell other doctors about taking a specific antidepressants drug and the dose Patients’ family and caregivers should monitor patients carefully for sociality. Tell the patient not to accelerate the effect of antidepressant drugs because it may take the patient 2-3 weeks of SSRIs, 2-4 weeks of MAOIs, and 4-6 weeks of TCAs to feel better. Reassure patient with sexual problems and tell him that it is temporary problem. Increase patient awareness about side effects of antidepressants and how to avoid or treat it. Tell patient that stopping antidepressant drugs treatment abruptly or missing several doses may cause withdrawal like symptoms this is sometimes called discontinuation syndrome Drowsiness

20. Thank You