1. Drugs Used for Mood Disorders
Chapter 17
Drugs Used for Mood Disorders
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2. Chapter 17
Lesson 17.1
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3. Objectives Discuss the mood swings associated with bipolar disorder
Differentiate between the physiologic and psychological therapeutic responses seen with antidepressant therapy
Compare drug therapy used during the treatment of the manic and depressive phases of bipolar disorder
Describe the essential components of a baseline assessment of a patient with depression or bipolar disorder
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4. Objectives (cont’d)
Cite monitoring parameters used for patients taking monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants
Identify the premedication assessments necessary before the administration of MAOIs, SSRIs, SNRIs, tricyclic antidepressants, and antimanic agents
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5. Mood Disorders
Present when certain symptoms impair a person’s ability to function for a time
Characterized by abnormal feelings of depression or euphoria
Underlying causes still unknown
Changes in brain neurotransmitters
Negative life events
Endocrine abnormalities
Genetic factors
Medications taken for other diseases
15% to 20% of the U.S. population has a diagnosable mood disorder in their lifetime.
Divided into four primary types: major depressive disorder, dysthymia, bipolar disorder, and cyclothymia.
Patients have a high incidence of attempting suicide.
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6. Depression Emotional symptoms Physical symptoms Cognitive symptoms
Sadness, no enjoyment of usual activities
Physical symptoms
Fatigue, sleep disturbances, appetite disturbances, stomach complaints, heart palpitations
Cognitive symptoms
Inability to concentrate, slowed thinking, poor memory, confusion
Psychomotor symptoms
Slowed movements, slowed speech, may exhibit agitation
Both the patient and family must understand the importance of taking medications.
Most people go untreated because of social stigma, financial barriers, underrecognition by health care providers, and underappreciation by the public about the benefits of treatment.
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7. Bipolar Disorder
Episodes of mania (euphoria) and depression, separated by intervals without mood disturbances
Paranoid or grandiose delusions during manic phase
Drug treatment includes mood stabilizing agents
Lithium (Eskalith, Lithane)
Anticonvulsant drugs
Formerly known as manic depression.
Mood swings are what differentiates bipolar disorder from depression.
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8. Treatment of Mood Disorders
Requires both nonpharmacologic and pharmacologic therapy
Three phases occur before full functioning is restored:
1. Acute phase: 6 to 8 weeks
Symptoms monitored
Doses adjusted
Psychotherapy initiated
Cognitive-behavioral therapy, psychodynamic therapy, and interpersonal therapy are important treatments.
Some patients become noncompliant during the acute phase.
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9. Treatment of Mood Disorders (cont’d)
2. Continuation phase: 4 to 9 months
Consolidates initial response into complete recovery
Uses pharmacotherapy and psychotherapy
Goal: Prevent relapse and have complete recovery (symptom free for 6 mos.)
3. Maintenance phase
Recommended for individuals with history of three or more depressive episodes, chronic depression, or bipolar disorder
Goal: Prevent recurrence
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10. Antidepressants Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs)
Miscellaneous agents
Each antidepressant has varying degrees of effect.
These drugs alter the availability of neurotransmitters within the brain.
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11. Selecting Therapy Two factors
Patient history of response to previously prescribed antidepressants
Potential for adverse effects associated with different antidepressants
No difference in overall efficacy but differences in adverse effects
Physiologic manifestations alleviated within first week of therapy
Psychological symptoms improve after 2 to 4 weeks
It is not possible to predict which drug will be most effective in a patient.
Some patients do not show a response with the first drug chosen but do with the second.
It may take 4 to 6 weeks to adjust the dosage to optimize therapy and minimize adverse effects.
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12. Assessment of Patients with Mood Disorders
Baseline assessment
History of mood disorder
Basic mental status
Interpersonal relationships
Mood, clarity of thought
Thoughts of death
Psychomotor function
Sleep pattern
Dietary history
Nonadherence
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13. Nursing Considerations for Mood Disorder Therapy
Individualized interventions
Environment of acceptance
Remain calm and firm
Provide safety for suicidal patients
Use physical restraints within guidelines
Provide for nutritional needs
Handle manipulative behavior consistently
Record observations; observing for suicidal ideation is a high priority.
Administer PRN drugs when necessary.
Use the least restrictive form of restraint; have sufficient staff available to control any situation.
Provide positive reinforcement.
Employ therapeutic communication techniques.
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14. Drug Class: MAOIs Actions Uses
Block metabolic destruction of norepinephrine, dopamine, and serotonin neurotransmitters by the enzyme monoamine oxidase
Uses
Most effective in atypical depression, panic disorder, obsessive-compulsive disorder, and some phobias.
When tricyclic antidepressant therapy is unsatisfactory
Neurotransmitters are increased in concentration with these medications.
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15. Drug Class: MAOIs (cont’d)
Drugs
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Selegiline (Emsam)
Common adverse effects
Orthostatic hypotension; drowsiness, sedation, restlessness, agitation, insomnia; blurred vision; constipation, dryness of mucosa of mouth, throat and nose; urinary retention
Serious adverse effects
Hypertension
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16. Nursing Considerations for MAOI Therapy
Premedication assessment
Obtain blood pressure and pulse rate
Ensure patient has not recently ingested meals with a high tyramine content
Check for medications taken before initiating therapy
Monitor blood glucose of diabetic patients
Most common adverse effect is orthostatic hypotension.
There is potential for hypertensive crisis.
Provide patient education of dietary products to avoid.
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17. Chapter 17
Lesson 17.2
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18. Objectives
Compare the mechanism of action of SSRIs to that of other antidepressant agents
Cite the advantages of SSRIs over other antidepressant agents
Examine the drug monograph for SSRIs to identify significant drug interactions
Prepare a teaching plan for an individual receiving SSRIs
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19. Drug Class: SSRIs Actions Uses Common adverse effects
Inhibit reuptake and destruction of serotonin from the synaptic cleft, prolonging the action of the neurotransmitter
Uses
Widely used antidepressants
Common adverse effects
Restlessness, agitation, anxiety, insomnia, sedative effects; GI effects
Serious adverse effects
Suicidal actions
For specific drugs, see Table 17-1.
SSRIs do not have anticholinergic or cardiovascular adverse effects.
Many drug interactions.
Be alert for possible serotonin syndrome, which occurs with increased serotonin levels.
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20. Drug Interactions for SSRIs
Tricyclic antidepressants – may cause dysrhythmias, seizure activity, CNS stimulation
Lithium (Eskalith, Lithane) – monitor for lithium toxicity
MAOIs – severe reactions including excitement, diaphoresis, rigidity, convulsions, death
Warfarin – enhances anticoagulant effect
Smoking – affects metabolism of fluvoxamine (Luvox) and may require higher dosage to be effective
Potential for severe reactions with the concurrent use of MAOIs and SSRIs.
Avoid bedtime doses to decrease insomnia.
Advise patients and families of the sedative effects.
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21. Drug Class: SNRIs
Drugs: desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor)
Actions
Inhibit reuptake and destruction of serotonin and norepinephrine from synaptic cleft
Uses
Widely used antidepressants
Common adverse effects
Dizziness, drowsiness, restlessness, agitation, anxiety, insomnia; nausea, anorexia
Serious adverse effect
Suicidal actions
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22. Drug Class: TCAs Actions Uses Common adverse effects
Prolong action of norepinephrine, dopamine, and serotonin by blocking reuptake
Uses
Antidepressant, mild tranquilizing effect, other uses
Common adverse effects
Orthostatic hypotension, sedative effects, blurred vision, constipation, dryness of the mouth, throat, and nose
For specific drugs, see Table 17-1.
All have anticholinergic activity.
Serious adverse effects: tremors, parkinsonian symptoms, seizure activity, dysrhythmias, tachycardia, heart failure, suicidal actions.
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23. Patient Education for TCAs
Drugs may cause orthostatic hypotension; monitor blood pressure daily
Sedative effects may occur, especially at onset of therapy
Rise slowly from sitting or supine position and lie down if feeling faint
Dryness of the mouth may be relieved by sucking on hard candy, ice chips, and gum
Blurred vision may occur
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24. Other Agents Bupropion hydrochloride (Wellbutrin, Zyban)
Mirtazapine (Remeron)
Nefazodone
Trazodone hydrochloride
Lithium carbonate (Eskalith, Lithane)
Disadvantages of bupropion include seizure activity and multiple daily doses.
Trazodone has a lower incidence of anticholinergic effects.
Lithium is used to treat acute mania associated with bipolar disorder.
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