McKenna's Pharmacology for Nursing, 2e

21

Antidepressant agents

Learning objectives Upon completion of this chapter, you should be able to: 1. Describe the biogenic theory of depression. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions and important drug–drug interactions associated with each class of antidepressant. 3. Discuss the use of antidepressants across the lifespan. 4. Compare and contrast the prototype drugs for each class of antidepressant with the other drugs in that class and with drugs in the other classes of antidepressants. 5. Outline the care considerations and teaching needs for people receiving each class of antidepressant.

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Glossary of keys terms affect: feeling that a person experiences when they respond emotionally to the environment biogenic amine: one of the neurotransmitters noradrenaline, serotonin or dopamine; it is thought that a deficiency of these substances in key areas of the brain results in depression depression: affective disorder in which a person experiences sadness that is much more severe and longer lasting than is warranted by the event that seems to have precipitated it, with a more intense mood; the condition may not even be traceable to a specific event or stressor monoamine oxidase (MAO) inhibitor: drug that prevents the enzyme monoamine oxidase from breaking down noradrenaline, leading to increased noradrenaline levels in the synaptic cleft; relieves depression and also causes sympathomimetic effects selective serotonin reuptake inhibitor (SSRI): drug that specifically blocks the reuptake of serotonin and increases its concentration in the synaptic cleft; relieves depression and is not associated with anticholinergic or sympathomimetic adverse effects tricyclic antidepressant (TCA): drug that blocks the reuptake of noradrenaline and serotonin; relieves depression and has anticholinergic and sedative effects tyramine: an amine found in food that causes vasoconstriction and raises blood pressure; ingesting foods high in tyramine while taking an MAO inhibitor poses the risk of a severe hypertensive crisis

TRICYCLIC ANTIDEPRESSANTS amitriptyline clomipramine dosulepin hydrochloride dothiepin doxepin

MONOAMINE OXIDASE INHIBITORS phenelzine tranylcypromine

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

OTHER ANTIDEPRESSANTS agomelatine bupropion desvenlafaxine mianserin mirtazapine moclobemide reboxetine selegiline venlafaxine

citalopram duloxetine escitalopram fluoxetine fluvoxamine paroxetine sertraline

imipramine nortriptyline trimipramine