Mood and Affect Medications PDF

## Antidepressants * SSRIs: Serotonin selective reuptake inhibitors - first line tx for depression * Inhibits reuptake of serotonin * Takes 1-3 weeks for effects * HRF SI & behaviors for children, teens & young adults (black box warning) * Serotonin syndrome can occur 2-72...

## Antidepressants * SSRIs: Serotonin selective reuptake inhibitors - first line tx for depression * Inhibits reuptake of serotonin * Takes 1-3 weeks for effects * HRF SI & behaviors for children, teens & young adults (black box warning) * Serotonin syndrome can occur 2-72 hrs of start of tx * Monitor for changes in weight, dry mouth, GI upset, flu like s/s, dizziness, HA (headache) * SNRIs: Serotonin (5HT) & norepinephrine (NE) reuptake inhibitors * Decreases reuptake of norepinephrine & serotonin * S/E similar to SSRI: elevated BP, N&V, dry mouth, constipation, dizziness, SI * Atypical: Does not fit into other categories; 2nd generation * Used to treat depression, psychotic d/o, anxiety d/o * Affect serotonin & dopamine * s/e: wgt gain, increased cholesterol, diabetes (metabolic syndrome, need to have 3/5 symptoms) * Tricyclics (TCA): block presynaptic reuptake of 5HT and NE -> increase effects of these at the receptors * Avoid if dx with urinary retention or closed angle glaucoma * Takes 2-4 weeks for effects * Monitor for anticholinergic effects (dryness, constipation) * MAOI: Monoamine inhibitors; blocks MAOI enzymes, increase NE, dopamine, 5HT, tyramine * Not first line of tx, very restrictive * Takes 2-4 weeks for effect (can take up to 12 weeks) * Meds: Nardil (phenelzine) and Parnate (tranylcypromine) ### Foods containing tyramine (MAOIs) MUST be avoided * Fermented or pickled foods * Cured meats (smoked and processed) * Alcohol beverages (red wines and liqueurs) * Aged cheeses (Swiss, parmesan, provolone, brie) * Tofu, beans, pineapples, plums, raspberries, nuts, raisins * Sauerkraut * Soy sauce * MSG ### Moderate tyramine with occasional consumption: * Chocolate * Yogurt, sour cream * Avocados, bananas * Gouda, processed American, mozzarella cheeses * White wine, coffee, colas, hot chocolate ### Low tyramine permissible consumption: * Figs, pasteurized cheeses (cream cheese, cottage cheese, ricotta) * Distilled spirits ### Pharm Cont. Anti-anxiety & Benzos * Used to treat anxiety and anxiety-related depression * These meds can come from various drug classes: benzos and barbiturates * Monitor for CNS effects * May experience hangover-type effects * Used to treat anxiety, insomnia, delirium, seizures, tension, tremors, muscle spasms, and used to sedate * Acts on the limbic, thalamic, and hypothalamic systems, causing relaxation effects * May cause drowsiness, sedation, do not stop abruptly * Avoid during pregnancy * HRF suicidal ideation if hx of substance abuse ## Anticonvulsants (AED) & Mood Stabilizer * AED: used to treat withdrawal syndromes, anxiety d/o, dementia, bipolar, schizophrenia * Affects mood * Has CNS effects * Affects GABA * Ex. valproic acid (Depakote), carbamazepine (Tegretol) * Lithium: mood stabilizer, used to treat mania, bipolar, major depression, schizoaffective, schizophrenia, eating disorders, phobias, ADHD, PTSD * Exact action is unknown; is a salt, alters NA transport to muscle and nerve cells * Narrow therapeutic window * Maintain steady fluid and electrolyte balance (sodium and water) * Contraindicated in pregnancy ## Antipsychotics/Neuroleptic Agents * Dopamine receptor blockers * Treat d/o of impaired thought process * Helps to organize thoughts * Takes several weeks for therapeutic effects * Crosses placenta and breast milk * Divided into two categories: typical and atypical ## Serotonin Syndrome * A toxic state caused by an increase in brain serotonin activity * Symptoms: * Neuromuscular: restlessness, myoclonus (uncontrollable jerking movements), tremor and rigidity, hyperreflexia * Others: shivering/elevated temp, arrhythmias, etc. * Can be fatal due to cardiac collapse * Causes: most often with combined or consecutive treatment with SSRIs, tricyclics, MAOIs, tryptophan, etc. * Treatments: stop drugs - usually resolves in no more than 24 hours, symptomatic measures (i.e., cooling, BDZs) * Prevention: take care when combining or switching serotonergic antidepressants ## Neuroleptic Malignant Syndrome * Potentially life-threatening reaction to antipsychotic drugs * Cause: after taking drug for first time or abrupt discontinuation of antipsychotic medications * Presentation: muscle rigidity, hyperthermia, vital sign instability (increased/decreased BP and tachycardia), diaphoresis, elevated creatine kinase * Nursing interventions: immediately stop taking medication, monitor fluid and electrolytes, cooling methods (ice packs, cool blankets), administer fever reducer, place on cardiac monitoring, provider may order muscle relaxer