Antidepressant.pptx

Antidepressant Mental Health Nursing Unit V

1. Presented by: Mr. P. Vethadhas M.Sc (N), Assistant Professor, Dept.of Mental Health Nursing. Unit - v ANTIDEPRESSANTS

2. ANTIDEPRESSANTS Antidepressants are those drugs, which are used for the treatment of depressive illness. These are also called as mood elevators or thymoleptics .

3. Indications

4. Depression Depressive episode Dysthymia Reactive depression Secondary depression Abnormal grief reaction

5. Childhood psychiatric disorders Enuresis Separation anxiety disorder Somnambulism School phobia Night terrors

6. Other psychiatric disorders Panic attack Generalized anxiety disorder Agoraphobia , social phobia OCD with or without depression Eating disorder Borderline personality disorder Post-traumatic stress disorder Depersonalization syndrome

7. Medical disorders Chronic pain Migraine Peptic ulcer disease

8. Pharmacokinetics Antidepressants are highly lipophilic and protein- bound.The half-life is long and usually more than 24 hours. It is predominantly metabolized in the liver.

9. Mechanism of Action The exact mechanism is unknown. The predominant action is by increasing catecholamine levels in the brain. TCAs are also called as Mono Amine Reuptake Inhibitors ( MARls ). The main mode of action is by blocking the reuptake of norepinephrine ( NE) and/ or serotonin (5-HT)at the nerve terminals, thus increasing the NE and 5-HTlevels at the receptor site.

10. Mechanism of Action MAOIs instead act on MAO ( monoamineoxidase ),which is responsible for the degradation of catecholamines after re-uptake. The final effect is the same, a functional increase in the NE and 5-HT levels at the receptor site. The increase in brain amine levels is probably responsible for the antidepressant action. It takes about 5 to 10days for MAOIs and 2 to 3 weeks for TCAs to bring down depressive symptoms. SSRIs act by inhibiting the re-uptake of serotonin and increasing its levels at the receptor site.

11. Side Effects

12. 1. Autonomic side-effects: Dry mouth Constipation Cydoplegia Mydriasis Urinary retention Orthostatic hypotension Impotence, impaired ejaculation Delirium and aggravation of glaucoma.

13. 2. CNS effects: Sedation Tremor and other extrapyramidal symptoms, Withdrawal syndrome Seizures Jitteriness syndrome Precipitation of mania.

14. 3. Cardiac side-effects : Tachycardia, ECG changes , Arrhythmias, Direct myocardial depression, Quinidine -like action (decreased conduction time).

15. 4. Allergic side-effects: Agranulocytosis Cholestatic jaundice Skin rashes Systemic vasculitis

16. 5. Metabolic and endocrine side-effects : Weight gain

17. 6. Special effects of MAOI drugs: Hypertensive crises, Severe hepatic necrosis, Hyperpyrexia.

18. Nurse's Responsibility for a Patient Receiving Antidepressants Most of the nurse's responsibilities for a patient on antidepressants are the same as for a patient receiving antipsychotics . In addition: Patients on MAOIs should be warned against the danger of ingesting tyramine -rich foods which can result in hypertensive crisis . Some of these foods are beef liver , chicken liver, fermented sausages, dried fish , over riped fruits, chocolate and beverages like wine, beer and coffee.

19. Cont.., Report promptly if occipital headache , nausea, vomiting, chest pain or other unusual symptoms occur ; these can herald the onset of hypertensive crisis. Instruct the patient not to take any medication without prescription. Caution the patient to change his position slowly to minimize orthostatic hypotension. Strict monitoring of vitals, especially blood pressure is essential.

20. Thank you