Pharmacology, part 18: Nervous System Medications for Depression

by Cathy Parkes

In this video

Tricyclic antidepressants - amitriptyline, imipramine

  • Indications
  • Mode of action
  • Side effects
  • Tip for remembering
  • Patient teaching

Monoamine oxidase inhibitors (MAOIs) - phenelzine, tranylcypromine

  • Indications
  • Mode of action
  • Side effects
  • Interactions
  • Patient teaching
  • Tip for remembering
  • Nursing care/patient teaching

Atypical antidepressants

Bupropion 

  • Indications
  • Tip for remembering
  • Mode of action
  • Side effects

Trazodone

  • Indications
  • Mode of action
  • Side effects
  • Patient teaching

Full Transcript

Okay, in this video we are going to focus on medications that are used to treat depression, including tricyclic antidepressants, MAOIs and atypical antidepressants.

Let's start with tricyclic antidepressants. So medications that fall within this class include amitriptyline as well as imipramine.

These medications can be used not only for depression but also neuropathy and fibromyalgia and sometimes we also use them for insomnia.

So the mode of action of tricyclic antidepressants is to increase the effect of serotonin and norepinephrine in the central nervous system.

There are a lot of side effects with this class of medication, so this includes sedation, orthostatic hypotension, as well as anticholinergic side effects, so remember with anticholinergic side effects I have my little PG13 tip, which is can't see, can't pee, can't spit and can't poop, right?

So you're going to get things like urinary retention, which is the can't pee part of that, constipation, can't poop, dry mouth, blurry vision, and photophobia. Those are going to be really important side effects to know with amitriptyline.

Other side effects can include dysrhythmias, sweating, and seizures.

So the way I remember this class of medication and some of the side effects is, I think of a girl named Amy who is walking along in the desert and trips over a tricycle. So that helps me to remember that amitriptyline is a key medication that is a tricyclic antidepressant. And because it's in the desert, she's sedated, she's sweating, and is very dry. So that helps me to remember all of the anticholinergic or drying side effects of amitriptyline. So hopefully, that's helpful for you as well. I know that little story has definitely helped people in the past to remember the key side effects with this medication.

So in terms of patient teaching, in order to kind of counteract those anticholinergic side effects, you should encourage your patient to chew gum, wear sunglasses, and increase their fluid and fiber intake to help counteract that constipation.

Now, let's talk about MAOIs, which are monoamine oxidase inhibitors. MAOIs include medications such as phenelzine and tranylcypromine.

MAOIs are used to treat depression.

And they work by inhibiting monoamine oxidase, which increases levels of dopamine, epinephrine, norepinephrine, and serotonin in the body.

Side effects can include agitation or anxiety as well as orthostatic hypotension, but the most important side effect to remember with MAOIs is that they can cause a hypertensive crisis. So it can send that blood pressure way up.

MAOIs interact with many, many medications. Chances are if you look up a medication on your drug reference guide and look at drug interactions, MAOIs are going to show up for a lot of medications. So they interact with many things, including over-the-counter cold products. So your patient who's on an MAOI will need to be very very careful about what other medications they take.

Another thing is that you're going to have to provide some important teaching to your patient who is on an MAOI. They are going to need to avoid foods that are rich in tyramines because this can also cause a hypertensive crisis. So foods that are rich in tyramines include kind of all these bougie foods like aged cheese, smoked meat, avocado, red wine, chocolate. So really all the yummy foods, they should avoid those because it can cause a hypertensive crisis.

So a rhyme that was submitted to us from a member of our Level Up RN crew is the following. With phenelzine, you can't eat life's finer things because they contain tyramines. So that's an amazing rhyme. I love it, and it will hopefully help you to remember that with MAOIs, which includes phenelzine, you can't have those tyramines.

Now, let's talk about some atypical antidepressants, which includes bupropion as well as trazodone.

Bupropion can be used not only for depression but as a smoking deterrent.

So a tip that my son gave me was, "Be appropriate with bupropion and don't smoke." So be appropriate, bupropion kind of sound similar, and it will help you to remember that, "Be appropriate and don't smoke."

So the mode of action of bupropion is to decrease reuptake of dopamine and norepinephrine.

Side effects can include insomnia - that's very common - in addition to headache, GI upset, weight loss, agitation, and a possible increase in the risk for seizures.

Trazodone is another atypical antidepressant.

It doesn't work as a smoking deterrent, but it is used for depression.

The mode of action is that it serves as a serotonin antagonist and reuptake inhibitor.

The key side effect with trazodone is sedation, so you're definitely going to want to advise your patient to avoid alcohol while taking trazodone because that can really exacerbate that side effect.

In addition, it can cause hypotension and dry mouth, and just like with all of our medications that cause dry mouth, you can advise your patient to chew gum or suck on hard candy to help with that dry mouth.

Okay. So in my next video, I will be talking about a few medications that can be used for both depression and anxiety, such as SSRIs and SNRIs, so hang in there with me!


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