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P A R T 4  Drugs acting on the central and peripheral nervous systems

CHAPTER SUMMARY ■■ Depression is a very common affective disorder; it is associated with many physical manifestations and is often misdiagnosed. It could be that depression is caused by a series of events that are not yet understood. ■■ Antidepressant drugs—TCAs, MAO inhibitors and SSRIs—increase the concentrations of the biogenic amines in the brain. ■■ Selection of an antidepressant depends on individual drug response and tolerance of associated adverse effects. The adverse effects of TCAs are sedating and anticholinergic; those of MAO inhibitors are CNS related and sympathomimetic. The adverse effects of SSRIs are fewer, but they do cause CNS changes. ■■ Other antidepressants with unknown mechanisms of action are also effective in treating depression. Knowing your strengths and weaknesses helps you to study more effectively. Take a PrepU Practice Quiz to find out how you measure up! ONLINE RESOURCES An extensive range of additional resources to enhance teaching and learning and to facilitate understanding of this chapter may be found online at the text’s accompanying website, located on thePoint at http://thepoint.lww.com. These include Watch and Learn videos, Concepts in Action animations, journal articles, review questions, case studies, discussion topics and quizzes.

www.aihw.gov.au/mental-health Australian Institute of Health and Welfare, National Priority Area—Mental Health. www.beyondblue.org.au Home page of Beyond Blue—The National Depression Initiative. www.nationaldrugstrategy.gov.au Australian Government National Drug Strategy. Anderson C. & Roy, T. (2013). Patient experiences of taking antidepressants for depression: A secondary qualitative analysis. Research in Social & Administrative Pharmacy, 9, 884–902. Australian Institute of Health and Welfare (AIHW). (2013). Mental health, www.aihw.gov.au/mental-health. Buist, A. (2008). Treatment of perinatal depression. Australian Prescriber, 31, 36–39. Casey, G. (2013). Antidepressants: Their role in treating depression. Kai Tiaki Nursing New Zealand, 19(8) , 20–24. Goodman, L. S., Brunton, L. L., Chabner, B. & Knollmann, B. C. (2011). Goodman and Gilman’s Pharmacological Basis of Therapeutics (12th edn). New York: McGraw-Hill. Lampe, L. (2005). Antidepressants: Not just for depression . Australian Prescriber, 28 , 91–93. McKenna, L. (2012). Pharmacology Made Incredibly Easy (1st Australian and New Zealand edn). Sydney: Lippincott Williams & Wilkins. McKenna, L. & Mirkov, S. (2014). McKenna’s Drug Handbook for Nursing & Midwifery (7th edn). Sydney: Lippincott Williams & Wilkins. Porth, C. M. (2011). Essentials of Pathophysiology: Concepts of Altered Health States (3rd edn). Philadelphia: Lippincott Williams & Wilkins. Porth, C. M. (2009). Pathophysiology: Concepts of Altered Health States (8th edn). Philadelphia: Lippincott Williams & Wilkins. Rahman, S. Z., Basilakis, J., Rahmadi, A., Lujic, S., Musgrave, I., Jorm, L., Hau, P. & Munch, G. (2013). Use of serotonergic antidepressants and St John’s wort in older Australians: A population-based cohort study. Australasian Psychiatry, 21(3) , 262–266. Williams, A. V. (2007). Antidepressants in pregnancy and breastfeeding. Australian Prescriber, 30, 125–127. BIBLIOGRAPHY

WEB LINKS

Healthcare providers and students may want to consult the following Internet sources:

C H E C K Y O U R U N D E R S T A N D I N G

2. When teaching a person receiving tricyclic antidepressants (TCAs), it is important to remember that TCAs are associated with many anticholinergic adverse effects. Teaching about these drugs should include anticipation of: a. increased libido and increased appetite. b. polyuria and polydipsia. c. urinary retention, arrhythmias and constipation. d. hearing changes, cataracts and nightmares.

Answers to the questions in this chapter can be found in Appendix A at the back of this book.

MULTIPLE CHOICE Select the best answer to the following. 1. The biogenic amine theory of depression states that depression is a result of: a. an unpleasant childhood. b. GABA inhibition. c. deficiency of noradrenaline, dopamine or 5HT in key areas of the brain. d. blockages within the limbic system, which controls emotions and affect.