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prepared by Mohammad Mosad & Sofyan Ahmmad


Introduction Depression definition. Risk Factors. Etiology DSM-IV- Criteria for Depression. Antidepressant Classification.

Explain Nursing

each type. Care.

Summary. References

At the end of this lecture the students will be able to: 1-Define depression. 2-Know area of the brain affected by depression. 3- Describe mechanism of action. 4- list common indications for antidepressant medications. 5-list common antidepressant side effect.

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless. They may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, or problems concentrating, remembering details or making decisions; and may

Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains or digestive problems that are resistant to treatment may be present. Depressed mood is a normal reaction to certain life events, a symptom of some medical conditions (e.g., Addison's disease, hypothyroidism), a side-effect of various medical treatments (e.g., hepatitis C drug therapy), and a feature of certain psychiatric syndromes.


higher in women than men Family history Stressful life event Currant substance use Medical illness Few social


causes of depression have not

been clearly determined.


demonstrates that both

biological and psychosocial factors play a significant role, with a combination of factors ( multiple causality).

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do note include symptoms that are clearly due to a general medical condition, or moodincongruent delusions or hallucinations. (1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).Note:In children and adolescents, can be irritable mood.

3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.Note:In children, consider failure to make expected weight gains. (4) insomnia or hypersomnia nearly every day (5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) (6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) (8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) (9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are

ression nti dep a


medication is used in the

treatment of dysthmic disorder; major depression with melancholia or psychotic symptoms; depression associated with organic disease, alcoholism, schizoaffective, or mental retardation; depressive phase of bipolar disorder; and depression


drugs elevate mood and

alleviate other symptoms associated with moderate to sever depression. Specific groups are also used to treat chronic pain, premenstrual dysphoric disorder, panic disorder, social phobia, generalized anxiety disorder, and


drugs work to increase the

concentration of norepinephrine, serotonin, and/or dopamine in the body.


is accomplished in the brain by

blocking the reuptake of these neurotransmitter by the ( tricycles,

Attention deficit hyperactivity disorder. Bipolar disorder. Bulimia or anorexia. Dysthmic disorder. Major depression. Obsessive Compulsive Disorder. Panic Disorder. Schizoaffective disorder. Social Phobia.


Hypotension. Drowsiness or fatigue. Dry mouth. Constipation. Urinary retention. Palpitation or tachycardia. Blurred vision Tremor.

Diaphoresis. Sexual

Problem. Anxiety or agitation. Headache. Nausea or vomiting. Insomnia or nightmares. Hypertensive crisis ( only MAOI).


neck. Chest pain. Flushing. Chills. Sweating. Atropine psychosis ( anticholinergic delirium). Agitation. Confusion.

Disorientation. Dry,

flushed skin. Dilated pupils.

Monoamine Atypical

Oxidase Inhibitor (MAOIs).

or Novel antidepressants Serotonin Reuptake Inhibitors



antidepressants (TCAs).


are effective antidepressants, but their use is limited by their potential to cause severe adverse reactions and potentially fatal interactions, such as hypertensive crisis. Because MAOIs irreversibly inhibit monoamine oxidase, it may take up to 2 weeks after stopping the drug for normal metabolism to be restored.


Monoamine Oxidase Inhibitor

(MAOI) antidepressants that requires some very important food (Tyramin) and medication restrictions.


cheese. sausages () Salami. Pepperoni. Tofu. Pickled food () Smoked food. Snow pea pods.

Sauerkraut.() Fava

beans.() Avocado. More than 1 oz Chocolate. Red wine. Beer.() Brewers yeast.()

Amphetamines. General anesthetics. Local or spinal anesthesia. Asthma or fever medications. Ritalin. Cocaine. Morphine. Hydrocodone Stimulants Selective Serotonin reuptake Inhibitors. Percocet, percodan.

Generic & brand name

Side effect

Nsg internention

Phenelizne sulfate dizziness , vertigo, ((nardil muscle

Observe & report therapeutic effectiveness of twitching drug ,headache,, tremor Improvement in sleep pattern Confusion, memory Appetite &physical impairment, activity mania, ,hypertensive crisis weakness

Generic &brand name

Tranylcypromine ((PARNATE + (Isocarboxazide ( marplan

Side effect

Nsg intervention



Selegiline transdermal (EMSAM)

Headache, increase BP

Monitor BP*


are a class of drugs used primarily as antidepressants that were first introduced in the 1970s. They are named after their chemical structure which contains four rings of atoms and are closely related to the tricyclic antidepressants (TCAs) which contain three rings of atoms.


second oldest class of antidepressant drugs. Tricyclics block the reuptake of certain neurotransmitters. They are used less commonly now due to the development of more selective and safer drugs .


crisis, hypertensive

crisis, sever seizures, and tachycardia may occur when used with MAOIs.

&Generic Brand names

Side effect


Desipramine . Dry mouth (norpramin) Tremors (pertofrane) Blurred vision Bloating Weight gain Urinary retention

Monitor for therapeutic effectiveness* Monitor HR&BP during early phase of therapy* Drowsiness,dizziness,&orthostatic hypotension* are sign of impeding toxicity in pt in long term or high dose therapy Observe history of glaucoma* Norpramine tab contain tetrazine can cause* allergic reaction type including bronchial asthma

Nortiptyline Nortiptyline,inha ,aventyl) nce the effect (Pamelor &Of barbiturate Other CNS Depressant

Generic &brand names Side effect

NSG Intervention


Cognitive impairment, MI, NA STROK memory loss Same side effect NA Same side effect NA NA Same intervention NA Same intervention NA NA

(Amoxapine(asendine (Protripyline(vivactil (Imipramine (tofranil (Doxepin (sinequan (Amitriptyline (elvil

Generic &brand names Side effect (Maprotilline (ludioomil &Seizure, sedation Ant cholinergic, dry mouth Constipation &nausea

NSG Intervention Observe seizure


have a high potential for

cardiovascular toxicity.

Patients taking a TCA should have frequent cardiovascular monitoring, including electrocardiograms.

frontline antidepressant due to their low risk of side effects and overdose, as well as their efficacy. SSRI antidepressants are chosen over all other classes in the treatment of depression and anxiety in children, teens and the elderly.


Researchers also note that the SSRI medications don't work for up to 50% of the depressed or anxious people who try them -- the same failure rate as for the older antidepressants.

Generic & brand name Side effete (Nefazodon (serzone .Headache, nervousness ,Insomnia, drowsiness Anxiety tremor, light headache. Nausea , vomiting .Diarrhea. Dry mouth Anorexia. Taste change sweating

NSG Intervention assess safety as dizziness* report change in visual&


.Anger. Hostility, agitation NA .Hallucination. Hypomania , Confusion. Disorientation .Decrease concentration .Impaired memory. Fatigue Dry mouth. Shortness of breathing



are one of the newer antidepressant drugs. They have become the first choice of treatment for most patients. SSRIs lack most of the disturbing adverse effects that are associated with MAOIs and TCAs. However, a patient taking SSRIs still require careful monitoring to avoid dangerous adverse reactions and drug interactions.


of the more common adverse

reactions that occur with SSRIs include anxiety, insomnia, somnolence(,) and palpitations. The patient may also experience sexual dysfunction (either anorgasm or delayed ejaculation) or skin rashes.

Antidepressant - Wikipedia , the free encyclopedia ../ wiki/Anti depressant