Antidepressants, Mood Stabilizers and Antipsychotics

Antidepressant Classes and Nursing Care

Antidepressants are prescribed to treat depressive disorders and related mental health conditions. These medications typically require two to four weeks of continuous therapy before a client experiences noticeable therapeutic effects. Because stopping these drugs suddenly can lead to uncomfortable discontinuation symptoms, the practical nurse reinforces teaching that clients must never stop taking their antidepressants abruptly without prescriber guidance. Additionally, the practical nurse reinforces teaching to avoid alcohol while taking psychotropic medications, as alcohol can worsen adverse effects and mental health symptoms.

All antidepressants carry a boxed warning regarding an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults. As therapy begins to lift depressive symptoms, physical energy often returns before mood improves. Because this temporary mismatch can give a client the physical ability to act on self-harm thoughts, the practical nurse must closely observe client behaviors. If a client shows a sudden increase in energy accompanied by a persistently depressed mood, the practical nurse reports this finding to the registered nurse immediately.

Specific antidepressant classes carry unique side effect profiles and clinical considerations. Selective serotonin reuptake inhibitors, or SSRIs, include fluoxetine, sertraline, citalopram, and paroxetine. Common side effects of SSRIs include insomnia, nausea, weight changes, and sexual dysfunction. Serotonin-norepinephrine reuptake inhibitors, or SNRIs, such as venlafaxine and duloxetine, can cause an increase in blood pressure, requiring regular blood pressure checks. Atypical agents also require targeted observations: bupropion increases seizure risk at high doses and is contraindicated in clients with current or prior anorexia nervosa or bulimia nervosa. Trazodone may be prescribed for insomnia in clients with depression and can rarely cause priapism, a prolonged, often painful erection that requires emergency care.

Tricyclic antidepressants, such as amitriptyline and nortriptyline, produce anticholinergic effects including dry mouth, constipation, and urinary retention. They can also cause orthostatic hypotension, so the practical nurse monitors blood pressure and reinforces teaching for clients to change positions slowly. An overdose of tricyclic antidepressants is life-threatening due to the risk of severe cardiac dysrhythmias. Monoamine oxidase inhibitors, or MAOIs, include phenelzine, tranylcypromine, and isocarboxazid. Clients taking an MAOI must avoid foods high in tyramine, such as aged cheeses, cured meats, and draft beer, because tyramine ingestion can trigger a life-threatening hypertensive crisis. Switching between an MAOI and most other antidepressants requires a washout period of at least 14 days, though clients must wait at least 5 weeks after stopping fluoxetine before starting an MAOI.