Pharmacology, part 19: Nervous System Medications for Anxiety and Depression

by Cathy Parkes

Selective serotonin reuptake inhibitors (SSRIs) - paroxetine, sertraline, fluoxetine.

  • Indications
  • Mode of action
  • Side effects
  • Black box warning
  • Tip for remembering
  • Serotonin syndrome
  • Contraindications
  • Nursing care/patient teaching

Serotonin-norepinephrine reuptake inhibitors (SNRIs) - duloxetine, venlafaxine

  • Mode of action
  • Side effects
  • Black box warning
  • Serotonin syndrome
  • Tip for remembering

Full Transcript

In this video, we are going to talk about some medications that are used for both depression and anxiety. If you are following along with cards, I'm on card 59 in our Pharmacology Edition 2.0 flashcards.

Let's first talk about selective serotonin reuptake inhibitors or SSRIs. This class of medication includes drugs such as paroxetine, sertraline, and fluoxetine. You can see that they all end in that tine type of ending.

So these medications can be used, like I said, for anxiety. They can also be used for depression as well as OCD and PTSD.

They work by inhibiting serotonin reuptake, which increases the amount of serotonin in your system.

So side effects of this include sexual dysfunction, which is very common with SSRIs as well as weight gain and insomnia.

There's also a black box warning with this medication because it could increase suicidal thoughts in some patients.

So the way I remember that fluoxetine, paroxetine, sertraline all are used for depression or anxiety is that if you live with a teen, like I do, then there may be times where you feel like you need a medication for anxiety or depression because teens are a piece of work sometimes, especially during a pandemic. Anyway, so that's my little tip.

When your patient is on an SSRI, you need to carefully monitor your patient for serotonin syndrome, and this is a very important point. So symptoms of serotonin syndrome include agitation, hallucinations, fever, diaphoresis, which is sweating, as well as tremors. So everything's kind of amped up. You're sweating, hallucinating, have a fever. If your patient has those symptoms and they're on an SSRI, then you definitely need to suspect serotonin syndrome.

Also keep in mind is that you don't want to take this concurrently with St. John's wort because that can increase the patient's risk for getting serotonin syndrome.

And then also keep in mind that when a patient first starts on an SSRI, it takes several weeks before they really start feeling the effects of this medication.

Alright, now let's talk about SNRIs. These are serotonin-norepinephrine reuptake inhibitors.

So unlike what we had with SSRIs where we were inhibiting the reuptake of just serotonin, with these medications, we are inhibiting the reuptake of both serotonin and norepinephrine, which increases the amount of serotonin and norepinephrine we have in the body.

Medications that fall within this class include duloxetine and venlafaxine.

So side effects with SNRIs include fatigue, insomnia, GI upset including constipation and possible nausea, dysuria, and decreased libido.

We also have a black box on this medication because it can increase the risk of suicidal thoughts in patients who take SNRIs.

So when the patient is on an SNRI, of course, you're going to want to monitor for serotonin syndrome because with this medication we're also increasing levels of serotonin.

So again, those important symptoms to remember are agitation, hallucinations, fever, diaphoresis, and tremors.

So my little trick for remembering at least one of these medications is, "I don't need a deluxe apartment to be happy, I just need to take duloxetine for my depression." So hopefully that will help you remember that duloxetine is for depression and it is an SNRI.

So that is it for this video. When we come back, we will talk about medications that are used for bipolar disorder. Hang in there with me!


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