ANTI
DEPRESSANTS
Drugs
used to elevate mood and alleviate other symptoms associated with moderate to
severe depression.
Classification
l .
Tricyclics : e.g. Imipramine,
Desipramine, Amitriptyline
2. Tetracyclics
: Amoxapine
3. Monoamine
Oxidase Inhibitors : e.g. Tranylcypramine, Phenelzine
4. Selective
Serotonin Reuptake Inhibitors(SSRIs) : e.g. Fluvoxamine.
5. Novel
Antidepressants- e.g. Bupropion, Trazadone,Venlafaxine
Action
·
Increase the catecholamine levels in the brain
·
TCAs blocking the reuptake of NE and 5-HT at the
nerve terminals, thus increasing the NE and 5-HT levels at the receptor site
·
Mono amines are responsible for the degradation
of catecholamines after reuptake; so MAOIs increase the NE and 5-HT levels at
the receptor site
·
SSRIs inhibits the reuptake of serotonin
Pharmacokinetics
·
Absorption -from GIT
·
Distribution -bound to plasma protein and tissue protein
·
Metabolism -liver
·
Excretion -kidney
Indication
l)
Depression:
2)Childhood
Psychiatric Disorders: Enuresis, Separation anxiety disorder, Somnambulism,
School phobia, Night terrors
3)Other
Psychiatric Disorders: Panic attack, Generalized anxiety disorder, Agora
phobia, Social phobia, OCD, Eating disorder, Borderline personality disorder,
PTSD, Depersonalization syndrome
4)
Medical disorders: Chronic pain, Migraine, Peptic ulcer disease
Contra
indications
·
Hypersensitivity
·
Recovery phase from myocardial infarction
·
Elderly or debilitated with hepatic, renal,
cardiac insufficiency
·
History of seizure disorder
·
Pregnancy and lactation
Side
effects
Autonomic
side effects-
Dry
mouth, blurred vision, dry eyes, constipation, urinary retention, cycloplegia,
mydriasis, delirium, orthostatic hypotension
cardiac
effects-
tachycardia,
arrhythmias and hypotension. Amitriptyline is
considered most cardiotoxic drug
CNS effects
sedation,
confusion, disorientation, anxiety, insomnia, ataxia, tremors, seizures
Hypertensive
crisis with MAOIs-
palpitation,
tightness in chest, stiff neck, throbbing and radiating head ache. High blood
pressure with the elevation of heart rate is common.
Sexual
side effects:
impotence,
impaired ejaculation, anorgasmia
Rare
effects:
agranulocytosis, jaunuice, Skin rashes, systemic vasculitis
Weight
gain
Nurses
responsibility
·
Clients on MAOI should be warned against danger
of tyramine rich foods which results in
hypertensive crisis. They are beef liver, chicken liver, dried fish, over ripped fruits, chocolates, wine, beer,
coffee etc.
·
Report for unusual symptoms like occipital
headache, nausea, vomiting, chest pain.
·
Instruct not to take medication without
prescription
·
Caution the patient to change his position
slowly to minimize orthostatic hypotension
·
Strictly monitor of vital signs, especially
blood pressure
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