Chapter 23: Antidepressants & Mood Stabilizer Drugs

Antidepressants & Mood Stabilizer Drugs begins by elucidating the pathophysiology of depression, emphasizing the monoamine theory which attributes symptoms to insufficient CNS concentrations of norepinephrine, serotonin, and dopamine, while distinguishing between reactive, major, and bipolar depression types. The text provides a detailed classification of antidepressant agents, starting with Tricyclic Antidepressants (TCAs) such as amitriptyline and imipramine, which inhibit neurotransmitter reuptake but are often limited by significant anticholinergic side effects, sedation, orthostatic hypotension, and cardiotoxicity risks. The discussion progresses to Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine and sertraline, which are currently favored for their improved safety profile despite potential adverse effects like sexual dysfunction and the risk of serotonin syndrome when combined with herbal supplements like St. John's wort. Furthermore, the summary covers Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), atypical antidepressants, and Monoamine Oxidase Inhibitors (MAOIs), with the latter requiring stringent dietary restrictions to avoid fatal hypertensive crises caused by tyramine-rich foods such as aged cheeses, organ meats, and wines. Shifting to bipolar disorder, the chapter focuses on mood stabilizers, identifying lithium as the primary antimania agent while stressing its narrow therapeutic index (0.8 to 1.2 mEq/L) and the inverse relationship between serum lithium and sodium levels that necessitates careful electrolyte monitoring to prevent toxicity. Alternative treatments utilizing anticonvulsants like carbamazepine, valproic acid, and lamotrigine are also reviewed. Finally, the content outlines the nursing process, prioritizing the assessment of suicidal ideation, the management of therapeutic lag time, and the critical importance of patient education regarding drug interactions, teratogenic risks, and adherence to medication regimens.