Antidepressant agents

Antidepressant agents

Clinical Indications

  • Dysthymia, major depressive disorder, depression associated with organic disease, alcoholism, schizophrenia, intellectual disability, depressive phase of bipolar disorder, and depression accompanied by anxiety

Medication action

  • Increase concentration of norepinephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, tetracyclic, SSRI’s, SNRI’s) or by inhibiting the release of monoamine oxidase inhibitors (MAOI’s).

Drug interactions

Drug Interactions with SSRI

Interacting Drugs

Adverse effects

Buspirone (BuSpar), TCA’s (especially clomipramine), Selegiline (Eldepryl), Saint John’s Wort

Serotonin syndrome

MAOI’s

Hypertensive crisis

Warfarin, NSAID’s

Increased risk of bleeding

Alcohol, benzodiazepines

Increased sedation

Antiepileptics

Lowered seizure threshold

Drug Interaction with TCA’s

Interacting Drugs

Adverse effects

MAOI’s

High fever, convulsions, death

Saint John’s Wort, tramadol (Ultram)

Seizures, serotonin syndrome

Clonidine (Catapres), epinephrine

Severe hypertension

Acetylcholine blockers

Paralytic ileus

Alcohol and carbamezipine (Tegretol)

Block antidepressant action, increases sedation

Cimetidine (Tagamet), bupropion (BuSpar)

Increased TCA blood levels, increased side effects

Drug Interactions with MAOI’s

Interacting Drugs

Adverse effects

SSRI’s, TCA’s, atomoxetine (Strattera), duloxetine (Cymbalta), dextromethorphan (an ingredient in many cough syrups), venlafaxine (Effexor), St. John’s Wort, Ginkgo

Serotonin syndrome

Morphine and other narcotic pain relievers, antihypertensive

Hypotension

All other antidepressants, pseudoephedrine, amphetamines, cocaine cyclobenzaprine (Flexeril), dopamine, methyldopa, levodopa, epinephrine, buspirone (BuSpar)

Hypertensive crisis (these side effects can occur even if take with 2 weeks of stopping MAOI’s)

Buspirone (BuSpar)

Psychosis, agitation, seizures

Antidiabetics

Hypoglycemia

Tegretol

Fever, hypertension, seizures

Nursing diagnosis

  • Risk for suicide
  • Risk for injury
  • Social isolation
  • Risk for constipation
  • Insomnia