Antidepressant and Mood Stabilizer Drug Therapy

Antidepressants are medications primarily used to treat major depressive disorder, which is a condition associated with a persistent feeling of sadness and loss of interest in everyday activities.

There are five classes of antidepressant medications, including tricyclic antidepressants, or TCAs, selective serotonin reuptake inhibitors, or SSRIs, serotonin and norepinephrine reuptake inhibitors, or SNRIs, monoamine oxidase inhibitors, or MAOIs, and atypical antidepressants.

Mood stabilizers are used to treat bipolar disorder, which is manifested by alterations in mood and behavior, vacillating between mania and depression.

Examples of mood stabilizers include lithium, carbamazepine, valproic acid, divalproex, and lamotrigine. First, let’s focus on the SSRI sertraline.

Sertraline is taken orally, and is rapidly absorbed into the bloodstream. Once it travels to the brain it inhibits the reuptake of serotonin, increasing the level of serotonin within the synaptic cleft.

Now, sertraline affects different types of receptors in the brain, such as those that regulate sleep, appetite, or sexual function, so sertraline can cause insomnia, loss of appetite or weight gain, and sexual dysfunction.

Sertraline can also cause hyponatremia, possibly by increasing the secretion of antidiuretic hormone. Some other side effects are anxiety, nausea, diarrhea, constipation, and bruxism, or teeth clenching and grinding.

Now, as far as contraindications and cautions go, SSRIs like sertraline can increase the risk of bleeding, especially if given along with antiplatelet or anticoagulant medications.

Additionally, sertraline can cause serotonin syndrome, which usually occurs when combined with other antidepressants that increase the level of serotonin in the brain, especially MAOIs.

Patients that develop serotonin syndrome typically present with skin flushing, hyperthermia, agitation, muscle rigidity, seizures, altered mental status, or even coma.

Sertraline should be used with caution during pregnancy, as well as in patients with hepatic impairment, acute angle-closure glaucoma, and risk factors for QT prolongation.

An important Black Box warning for all antidepressants is that they can increase the risk of suicidal thinking in children, adolescents, and young adults.

So patients will need to be monitored closely, especially when starting treatment or changing dosage. Okay, let’s switch gears and talk about lithium.

Lithium is taken orally and is rapidly absorbed and widely distributed throughout the body. It’s thought to work by altering ion transport across cell membranes, allowing sodium ion transport into nerve cells, and resulting in a change in catecholamine metabolism.

Some of lithium’s side effects include increased thirst, polyuria fatigue, confusion, muscle weakness, and fine hand tremors.

It can also cause cardiac arrhythmias, due to its effects on ion channels, as well as goiter and hypothyroidism due to inhibition of thyroid hormone secretion.

Lithium should be used with caution during pregnancy, as well as in patients with renal disease. Importantly, lithium can cause nephrogenic diabetes insipidus, dehydration, and hypernatremia Finally, lithium has a short half-life, and this increases its risk for toxicity, even at normal, therapeutic doses.

So it has a Black Box warning to routinely check lithium levels. Administering it in divided daily doses can decrease the risk of toxicity.

Now, before administering sertraline or lithium, obtain a baseline assessment of your patient’s symptoms and complete a suicide risk assessment .

Observe their behaviors and affect, and ask them about recent changes in appetite, sleep patterns, and other activities.

Next, assess their baseline vital signs and weight, and review diagnostic tests such as kidney and liver function tests, and pregnancy status.

During the first few weeks of treatment, monitor your patient closely for suicidal thoughts, and make arrangements for them to meet with their health care provider regularly.

Monitor them closely for side effects, and evaluate the effectiveness of treatment. Then, ensure your patient understands why the medication has been prescribed.

Stress the importance of taking their medication exactly as directed and remind them that they should not stop taking it abruptly, even when they start feeling better.

Also remind them that it may take a few weeks before they start feeling the therapeutic effects of their medication. For patients taking lithium, remind them to keep their daily fluid and sodium intake consistent, and explain how this helps the kidneys keep their lithium level within a safe range.

Stress the importance of having their lithium level checked on a regular basis, and teach them to recognize signs of toxicity including weakness, worsening tremor, ataxia, poor concentration, and diarrhea.

Advise them to seek help immediately if they develop vomiting, slurred speech, or confusion. Finally, for clients of childbearing age, stress the importance of using an effective birth control method when taking these medications and instruct your patient to inform their health care provider if they think they might be pregnant.

Alright, as a quick recap… Sertraline is an SSRI commonly prescribed in the treatment of depression that works by inhibiting the reuptake of serotonin.

Lithium is a mood stabilizer medication used to treat bipolar disorder and is thought to work by altering ion transport across cell membranes.

Nursing considerations include monitoring for side effects and for the effectiveness of treatment, especially suicidal thinking and lithium toxicity, as well as providing patient education.