- Body system
- Mental health
- Name stem
- -oxetine, -aline, -triptyline
- Drug cards
- 2 in this guide
Drugs in this class
Other examples: Escitalopram, Citalopram, Paroxetine, Venlafaxine, Duloxetine, Bupropion, Mirtazapine, Amitriptyline, Phenelzine.
How antidepressants work
Increase the availability of serotonin and/or norepinephrine (and dopamine for bupropion) by blocking reuptake (SSRIs, SNRIs, tricyclics), blocking breakdown (MAOIs) or acting on receptors (mirtazapine).
Uses
- Major depression
- Anxiety disorders, OCD and PTSD
- Neuropathic pain (duloxetine, tricyclics)
- Smoking cessation (bupropion)
Adverse effects
- SSRIs and SNRIs: nausea, sexual dysfunction, insomnia, hyponatremia, bleeding risk
- Tricyclics: anticholinergic effects, sedation, orthostatic hypotension, cardiac toxicity in overdose
- MAOIs: hypertensive crisis with tyramine-rich foods
- Bupropion: lowers the seizure threshold
Nursing considerations
- Assess suicide risk, especially in the first weeks and after dose changes.
- Watch for serotonin syndrome: agitation, hyperthermia, tachycardia, diaphoresis, tremor, hyperreflexia and clonus.
- Allow a 14-day washout between an MAOI and other serotonergic antidepressants (5 weeks after fluoxetine).
Patient teaching
- Benefits take 2 to 6 weeks; do not stop early.
- Do not stop suddenly.
- On an MAOI, avoid tyramine-rich foods: aged cheese, cured or smoked meats, tap beer, soy sauce and fermented products.
Antidepressants NCLEX practice questions
Answer each question to see the rationale.
3 questions. Choose an answer to see the rationale.
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A patient started sertraline 10 days ago and says it is not working. What is the best response?
Show answer
Answer B: Full benefit usually takes several weeks; keep taking it as prescribed SSRIs often need 4 to 6 weeks for full effect. Monitor mood and suicide risk during this period.
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Which finding suggests serotonin syndrome?
Show answer
Answer A: Agitation, hyperthermia, tremor and muscle twitching Serotonin syndrome causes mental status changes, autonomic instability (fever, tachycardia, sweating) and neuromuscular hyperactivity (tremor, clonus).
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A patient taking phenelzine should avoid which food?
Show answer
Answer C: Aged cheddar cheese Phenelzine is an MAOI. Aged cheese is rich in tyramine, which can cause a hypertensive crisis.
Frequently asked questions
What are antidepressants?
Antidepressants include SSRIs, SNRIs, tricyclics, MAOIs and atypical agents. Every antidepressant carries a suicide warning for young people, and serotonin syndrome is the key drug-interaction danger.
How do antidepressants work?
Increase the availability of serotonin and/or norepinephrine (and dopamine for bupropion) by blocking reuptake (SSRIs, SNRIs, tricyclics), blocking breakdown (MAOIs) or acting on receptors (mirtazapine).
What are examples of antidepressants?
Sertraline, Fluoxetine, Escitalopram, Citalopram, Paroxetine, Venlafaxine, Duloxetine and Bupropion.
What are the nursing considerations for antidepressants?
Assess suicide risk, especially in the first weeks and after dose changes. Watch for serotonin syndrome: agitation, hyperthermia, tachycardia, diaphoresis, tremor, hyperreflexia and clonus.