We're gonna introduce you to antidepressants in this section
and this is one of the most common ones that's prescribed.
Selective serotonin reuptake inhibitors, SSRIs.
Now, I'm sure you're very familiar with the clinical features of depression.
We've listed those for you here just to kind of remind you
but they need to be present at most of the day, nearly every day for at least 2 weeks
for a clinical diagnosis of depression.
Now, we can treat it through a variety of symptoms.
We're focusing on pharmacotherapy but you can also use psychotherapy,
particularly cognitive brain therapy, electroconvulsive therapy,
and vagus nerve stimulation in severe cases.
But where are we focusing? Pharmacotherapy.
That's the primary therapy that we'll be addressing for this pharmacology review.
Now, some classic known risks are that we want you to keep in mind
that the suicide risk with antidepressants may increase early in the treatment.
So you'll known as a nurse, to keep them safe, they need an extra close observation
as you're just starting a treatment plan to make sure that they're safe.
So patients should be observed closely for suicidality, thoughts about suicide,
worsening mood, or any unusual changes in behavior.
They try to give the smallest amount of medication that is still effective but keeping in mind,
as the patient is receiving that medication initially, there are at increased risk for suicide.
Now, SSRIs increase the amount of serotonin that's circulating in the synapses in the brain
because it stops the reuptake of serotonin right at the neuron.
Examples of names are on your screen.
Again, you've got the trade name and the generic name
but make sure you're familiar with the generic names.
Now, we use it to treat depression.
We already knew that because these are antidepressants but it also has other benefits.
It can help with OCD, social anxiety disorder, post-traumatic stress syndrome, and panic disorder.
It can help with eating disorders and some other special types of depression
like premenstrual dysphoric disorder.
This type of depression is uniquely timed with the menstrual cycle.
And lastly, enuresis. I wouldn't memorize that.
Really, what I would be thinking about with SSRIs are depression and OCD.
The other ones are interesting to know but I would really focus most on depression and OCD.
SSRIs used for depression take a little while for the patient to actually feel the full effect.
10 days to 21 days may take for each patient to feel the effect.
Now, when you wean the meds, you don't wanna just stop them abruptly
so you wanna make sure your patient understands that it's important that they work
with the health care provider if they're gonna stop taking a medication
so they know exactly how to wean it safely.
The patients having some issues with cholinergic effects, you can encourage them
to take it at bedtime to deal with those.
It's a good idea to take it with food and if their sleep isn't disturbed,
this sometimes is the best time to take these medications.
If this SSRI's causing sleep disturbances, they're gonna have to work with the patient
on the anticholinergic effects and move that dosage to the morning.
Now, the side effects of SSRI involve insomnia for some patients.
So you would say, why would we recommend it at bedtime?
Some people don't have a problem with it but others, it's very disruptive.
So side effects, here's the possible options they might have.
Insomnia, anxiety, nervousness, headache.
A lot of these medications come with a risk for weight gain
so that's something you wanna let the patient know, be pro-active about it,
and let them know that patients often experience weight gain on these medications
so we just have to kinda program around it.
It might also upset their stomach initially
and the dry mouth that comes around with anticholinergic effects.
So putting these side effects in order from head to toe,
that's why we've kinda rearranged them to encourage your brain to look at it from a different perspective.
So insomnia, anxiety, nervousness, headache, weight gain,
nausea, GI distress, dry mouth, sexual dysfunction.
A lot of patients express some dissatisfaction with this.
That it's difficult for them to experience extreme pleasure in sexual interactions
so they have sexual dysfunctions that go along with this medication.
So that would involve you really working with the patient
and helping them know that yes, this is a possibility but we can work through that.
Now, serotonin syndrome is an autonomic instability and it can be life-threatening.
You know what you know about neuroleptic malignant syndrome,
now let's look at this risk for serotonin syndrome.
Sweating, agitated, confused, hyperreflexia, hallucinations, fever, tremor, incoordination.
See, all those listed there, they sound familiar yet a little different than neuroleptic malignant syndrome.
Definitely wanna recognize the psych meds always have the risk of antipsychotics,
neuroleptic malignant syndrome, SSRIs, serotonin syndrome.
Now, if an SSRI doesn't work, we can use other medications that are called SNRIs and NDRIs.
Serotonin-norepinephrine reuptake inhibitor or norepinephrine-dopamine reuptake inhibitors.
So we've got the names there so you can recognize them.
They have a similar effect where they block the uptake of those neurotransmitters.