Use of Antidepressants in Different Age Groups
抗抑郁药在不同年龄组的使用
CHILDREN 儿童
Use of antidepressant drugs with children poses a challenge. The response of the child to the drug may be unpredictable, and the long-term effects of many of these agents are not clearly understood. Studies have not shown efficacy in using these drugs to treat depression in children and also indicate that there may be an increase in suicidal ideation and suicidal behavior when antidepressants are used to treat depression in children.
Of the tricyclic drugs (TCAs), clomipramine, imipramine, nortriptyline, and trimipramine have established pediatric doses in children older than 6 years. Children should be monitored closely for adverse effects, and dose changes should be made as needed.
Monoamine oxidase (MAO) inhibitors should be avoided in children if at all possible because of the potential for drug–food interactions and the serious adverse effects. The selective serotonin reuptake inhibitors (SSRIs) can cause serious adverse effects in children. Fluvoxamine and sertraline have established pediatric dose guidelines for the treatment of obsessive–compulsive disorders. Fluoxetine is widely used to treat depression in adolescents, and a 2000 survey of off-label uses of drugs showed that it was being used in children as young as 6 months. Dosage regimens must be established according to the child’s age and weight, and a child receiving an antidepressant should be monitored very carefully. Underlying medical reasons for the depression should be ruled out before antidepressant therapy is begun. Again, these children should be monitored for any suicidal ideation.
Adults using these drugs should have medical causes for their depression ruled out before therapy is begun. Thyroid disease, hormonal imbalance, and cardiovascular disorders can all lead to the signs and symptoms of depression. The patient needs to understand that the effects of drug therapy may not be seen for 4 weeks and that it is important to continue the therapy for at least that long. These drugs should be used very cautiously during pregnancy and lactation because of the potential for adverse effects on the fetus and possible neurological effects on the baby. Use should be reserved for situations in which the benefits to the mother far outweigh the potential risks to the neonate.
Older patients may be more susceptible to the adverse effects of these drugs, from unanticipated central nervous system (CNS) effects to increased sedation, dizziness, and even hallucinations. Doses of all of these drugs need to be reduced and the patient monitored very closely for toxic effects. Safety measures should be provided if CNS effects do occur. Patients with hepatic or renal impairment should be monitored very closely while taking these drugs. Decreased doses may be needed. Because many older patients also have renal or hepatic impairment, they need to be screened carefully.
unpredictable – a. 不可预测的
efficacy – n. 功效，有效性
clomipramine – n. 氯米帕明
imipramine – n. 丙咪嗪
nortriptyline – n. 去甲替林
trimipramine – n. 曲米帕明
fluvoxamine – n. 氟伏沙明
sertraline – n. 舍曲林
off-label uses – （药品）核准标示外使用
medical reason – 医疗原因
medical cause – 医学原因
unanticipated – a. 不曾预料的
1. The client diagnosed with major depression who attempted suicide is being discharged from the psychiatric facility after a 2-week stay. Which discharge intervention is most important for the nurse to implement?
A. Provide the family with the phone number to call if the client needs assistance.
B. Encourage the client to keep all follow-up appointments with the psychiatric clinic.
C. Ensure the client has no more than a 7-day supply of antidepressants.
D. Instruct the client not to take any over-the-counter medications without consulting with the HCP. 2. The client with major depressive disorder is prescribed nefazodone (Serzone), an atypical antidepressant. The client tells the nurse, “I am going to take my medication at night instead of in the morning.” Which statement would be the nurse’s best response?
A. “You really should take the medication in the morning for the best results.”
B. “It is all right to take the medication at night. It may help you sleep at night.”
C. “The medication should be taken with food so you should not take it at night.”
D. “Have you discussed taking the medication at night with your psychiatrist?”
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答案 Answers
1. C. Ensure the client has no more than a 7-day supply of antidepressants.
Rationale: Ensuring the psychological and physical safety of the client is priority. As antidepressant medications become more effective, the client is at a higher risk for suicide. Therefore, the nurse should ensure that the client cannot take an overdose of medication. 2. B. “It is all right to take the medication at night. It may help you sleep at night.”
Rationale: Antidepressants may cause central nervous depression, which causes drowsiness. Therefore, taking the medication at night may help the client sleep at night and relieve daytime sedation. This is the nurse’s best response.
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