In this first of a two part series, Dr. Mohammed Soliman, MD, PhD, MBA speaks with us about the landscape of psychiatric medications, a discussion is geared towards hospitals nurses who work in non-psychiatric units such as medical-surgical floors, ICUs, or emergency departments.
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The five classes of psychotropic medications:
- Antidepressants
- Stimulants
- Anxiolytics
- Antipsychotics
- Mood stabilizers
Antidepressants
The two main classes of antidepressants addressed in this episode are SSRIs and SNRIs.
Selective serotonin reuptake inhibitors (SSRIs)
Common SSRIs
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
Important Teaching Points About SSRIs for Hospital Nurses
- While Fluoxetine (Prozac) has a relatively long half life of ~7 days, it’s important to continue your patient’s home doses of SSRIs to maintain stable blood levels
- SSRI withdrawal symptoms include flu-like symptoms, dizziness and headache
- SSRIs are the first line medication for depression due to it’s low side effect profile
Serotonin-noradrenaline reuptake inhibitors (SNRIs)
Common SNRIs
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor)
Important Teaching Points About SNRIs for Hospital Nurses
- Withdrawal effects from SNRIs are more severe than for SSRIs
- Because SNRIs increase norepinephrine levels, they are often prescribed for conditions that involve both depression and anxiety or pain.
Tricyclic Antidepressants (TCAs)
We didn’t talk about TCAs. Are they no longer used?
TCAs are still used but are less common due to severe side effects. They can also cause rapid heart rate, high blood pressure, and arrhythmias, which can be particularly dangerous in individuals with a history of heart disease.
Stimulants
Stimulants can also be used to treat conditions such as depression, bipolar disorder, and anxiety disorders. They may also be used off-label to help with symptoms such as fatigue, low motivation, and low energy.
The main stimulant discussed in this episode is Methylphenidate (Ritalin). Dr. Soliman explained that Methylphenidate can be prescribed for patients with terminal diseases for whom they don’t have enough time for SSRIs to start working.