Selective serotonin reuptake inhibitors (SSRIs), the newest group of antidepressant drugs, specifically block the reuptake of 5HT, with little to no known effect on NE. Because SSRIs do not have the many adverse effects associated with TCAs and MAOIs, they are a better choice for many patients. SSRIs include fluoxetine (Prozac), the first SSRI; citalopram (Celexa); duloxetine (Cymbalta), the newest SSRI; escitalopram (Lexapro), fluvoxamine (Luvox); paroxetine (Paxil); and sertraline (Zoloft).
The action of SSRIs blocking the reuptake of 5HT increases the levels of 5HT in the synaptic cleft and may contribute to the antidepressant and other effects attributed to these drugs.
SSRIs are indicated for the treatment of depression, OCDs, panic attacks, bulimia, premenstrual dysphoric disorder (PMDD), posttraumatic stress disorders, social phobias, and social anxiety disorders. A period of up to 4 weeks is necessary for realization of the full therapeutic effect. Patients may respond well to one SSRI and yet show little or no response to another one. The choice of drug depends on the indications and individual response. Ongoing investigations are focusing on the use of these antidepressant drugs in the treatment of other psychiatric disorders.
When administering medications, confusion about similar drug names may present a hazard, for example with Celexa (citalopram), Celebrex (celecoxib), Xanax (alprazolam), and Cerebyx (fosphenytoin). Use caution. Serious adverse effects have been reported, as well as important loss of therapeutic effects, when the wrong drug is given. If any of these drugs is ordered for your patient, make sure you know the indication for the drug, as well as the generic name of the prescribed drug.
1. The client with major depressive disorder is prescribed the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac). Which intervention should the nurse teach the client concerning this medication?
A. Instruct the client not to eat any type of tyramine-containing foods such as wines or cheeses.
B. Notify the health-care provider if the client becomes anxious or has an elevated temperature.
C. Encourage the client to take the medication with grapefruit juice.
D. Explain that tremors and sweating are initial expected side effects. 2. The client diagnosed with late-stage Alzheimer’s disease is agitated and having delusions. Which medication should the nurse anticipate the health-care provider prescribing?
A. The cholinesterase inhibitor donepezil (Aricept).
B. The antipsychotic medication haloperidol (Haldol).
C. The selective serotonin reuptake inhibitor fluoxetine (Prozac).
D. The tricyclic antidepressant amitriptyline (Elavil).
1. B. Notify the health-care provider if the client becomes anxious or has an elevated temperature.
Rationale: Serotonin syndrome (SES) is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), hypertension, tremors, sweating, hyperpyrexia (elevated temperature), and ataxia. Conservative treatment includes stopping the SSRI and using supportive treatment. If untreated it can lead to death. 2. B. The antipsychotic medication haloperidol (Haldol).
Rationale: Delusions and agitation respond to antipsychotic medications. Haldol has been used and has proven to be effective in treating these symptoms, so the nurse should anticipate this prescription.
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