Editing Mental Health and Psychosocial Nursing (section)

=== Antidepressants ===
* '''SSRIs''' (fluoxetine, sertraline, escitalopram, paroxetine, citalopram): first-line. Nausea, headache, insomnia or sedation, and sexual dysfunction are common. Full effect takes '''4 to 6 weeks'''; teach the client not to stop early. Abrupt discontinuation causes a discontinuation syndrome (dizziness, flu-like symptoms, paresthesias), so taper. Risk of hyponatremia in older adults and increased bleeding risk with NSAIDs or anticoagulants.
* '''SNRIs''' (venlafaxine, duloxetine): monitor blood pressure with venlafaxine.
* '''Bupropion''': no sexual side effects, aids smoking cessation, but '''lowers the seizure threshold'''; contraindicated in seizure disorder, bulimia, and anorexia.
* '''Mirtazapine''': sedation and appetite gain, sometimes used deliberately in older adults with weight loss and insomnia.
* '''Tricyclics''' (amitriptyline, nortriptyline, imipramine): anticholinergic effects, orthostatic hypotension, and '''lethal in overdose from cardiac conduction block'''; dispense limited quantities to at-risk clients.
* '''MAOIs''' (phenelzine, tranylcypromine, isocarboxazid): require a '''tyramine-restricted diet'''. Avoid aged cheese, cured and smoked meats, fermented foods, soy sauce, sauerkraut, tap and draft beer, red wine, fava beans, and overripe fruit. Tyramine causes '''hypertensive crisis''' with severe occipital headache, stiff neck, palpitations, and marked hypertension. Allow a '''2-week washout''' between MAOIs and most serotonergic agents (5 weeks after fluoxetine). Avoid combining with SSRIs, meperidine, or sympathomimetics.

'''Serotonin syndrome''': onset within hours of a serotonergic increase or combination. Mental status change, autonomic instability, hyperthermia, diaphoresis, diarrhea, and the distinguishing '''neuromuscular hyperactivity: hyperreflexia, clonus, and tremor, greater in the lower extremities'''. Stop the agent, provide supportive cooling and benzodiazepines, and consider cyproheptadine.