Antidepressants and Mood Stabilizers Key Points

MAOIs and Interactions

• Taking CNS stimulants or sympathomimetics, as well as tyramine-containing foods, with MAOIs can lead to a hypertensive crisis.
• Frequent blood pressure monitoring is essential for patients taking MAOIs to prevent hypertensive crisis.

Lithium

• A potential side effect of lithium use is nephrogenic diabetes insipidus.
• The therapeutic serum range for lithium is 0.5-1.5 mEq/L.
• If serum lithium levels exceed 1.5 mEq/L, it can lead to toxicity.
• Serum sodium levels should be monitored in patients taking lithium to prevent sodium depletion.
• Serum lithium levels should be monitored every 2-3 months after the therapeutic level has been obtained.
• Valproic acid, carbamazepine, and lamotrigine have been used in place of lithium for some patients.

Antipsychotics in Bipolar Disorder

• Olanzapine, ziprasidone, and aripiprazole are approved for use in bipolar disorder.
• Lithium use during pregnancy can increase the risk of cardiac anomalies and other birth defects.

Antidepressants

• Selective serotonin reuptake inhibitors (SSRIs) are more commonly used to treat depression than tricyclic antidepressants (TCAs).
• St. John's Wort decreases the reuptake of serotonin, dopamine, and norepinephrine.
• Venlafaxine affects various neurotransmitters and is used for major depression, reactive depression, and anxiety.
• The primary use of SSRIs is to treat depression.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) inhibit the reuptake of serotonin and norepinephrine, increasing their availability in the synapse.
• Polydrug therapy should be avoided if possible to prevent increased risk of adverse effects.

Tricyclic Antidepressants (TCAs)

• TCAs increase the availability of neurotransmitters in the synapse by inhibiting their reuptake.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Taking tryptophan supplements should be limited when taking SSRIs to avoid possible toxicity.

Major Depression

• Major depression is characterized by loss of interest in work and home, inability to concentrate and complete tasks, and difficulty sleeping or excessive sleeping.
• Signs of major depression include feelings of worthlessness, changes in appetite, and difficulty sleeping.
• A contributing cause of depression is a decrease in serotonin levels.
• Mood-stabilizer agents are effective for treating bipolar disorder.
• Major depression is the most common mental illness characterized by mood changes and loss of interest in normal activities.

Reactive Depression

• Reactive depression usually has a sudden onset after a precipitating event.