NCLEX® Practice: Client Education on Antidepressants

One of the biggest lectures in psychiatric nursing is antidepressants. Here, we’ll be focusing on the specific client education for every type of antidepressant which is most likely to come out in one of your nursing exams.

An Essential Pointer

A major necessity when taking care of clients with depression is to instruct them to take their antidepressants regularly, without missing a dose. Not taking antidepressants on a daily basis decreases the medication’s therapeutic range.

Usually, this type of drug will require at least two to three weeks for it to reach its maximum therapeutic effect.

Client Education Tips

The question that is commonly asked in nursing exams about antidepressants is, “How do you educate a client who complains that the medication is not working?” What are the key elements that you have to remember to efficiently and appropriately address this type of question?

  1. Antidepressants take time to take full effect.

Antidepressants take about two to three weeks to reach their therapeutic range, and it usually takes two to three months to attain maximum effects. A person can still be within a medication’s therapeutic range and not experience toxicity while still on the verge of getting the most out of the drug.

  1. Abrupt discontinuation may lead to a relapse.

Instruct your client not to terminate medication intake abruptly to avoid a relapse of the condition. Educating about relapses is important because there will be clients who might not take their medication on a daily basis and would even discard them once they feel better.

Letting clients know that relapse is inevitable will help them become more responsible in taking their medications. Weaning is better than immediate discontinuation of antidepressants.

  1. There is a risk for suicide.

One of the most significant issues when dealing with clients taking antidepressants is the increased risk of becoming suicidal in the first month of therapy; this is because, during the first month, clients are expected to come out of their depressive symptoms. Keep in mind that clients who have depression are not motivated and do not have the energy to do anything, especially when thinking about committing suicide.

Though clients are still depressed during the first month of therapy, they are snapping out of their unmotivated selves, and are becoming more energetic; thus they become more prone to carrying out the deed.

Client Education for every Antidepressant Medication

Different types of antidepressants are given to clinically depressed clients. We’ll go through each category and the essential takeaways you need for client education.

  1. Tricyclic antidepressants (TCAs)

For tricyclic antidepressants, there are two things that you have to remember:

  • Cardiac rhythms are primarily affected. Nurses have to observe for dysrhythmias that are caused by medication toxicity.
  • TCAs should be taken before bedtime because it causes sedation and orthostatic hypotension. Orthostatic hypotension is due to decreased blood pressure that increases a client’s risk for a fall.
  1. Selective Serotonin Uptake Inhibitors (SSRIs)

SSRIs are the exact opposite of TCAs with regards to the time when the medication should be taken. SSRIs are taken in the morning and not in the evening because these drugs cause insomnia. Remember that serotonin is a mood enhancer or stabilizer that can significantly improve a person’s energy level.

Inform your clients who are taking SSRIs to:

  • Avoid coffee.
  • Take SSRI medication with food to avoid gastrointestinal upset.
  • For old clients who are also taking diuretics, laboratory tests are necessary to determine the sodium levels.

Gastrointestinal problems can be experienced with SSRIs because 80% of serotonin produced by the body is located inside the gut and taking in more serotonin will definitely upset the system.

  1. Monoamine Oxidase Inhibitors (MAOIs)

When all else fails, MAOIs are the drugs to depend on. However, MAOIs are not as friendly as the other antidepressants when it cocmes to side effects. A couple of things to remember about MAOIs are:

  • MAOIs should not be taken with any other medications.
  • There is an increased risk for high blood pressure crisis.
  • Tyramine, a food ingredient, is contraindicated with MAOI. Cheese, wine, and certain meats like sausages are restricted when taking MAOI.
  • MAOIs cannot be given to bipolar clients.
  1. Atypical Antidepressants

One of the main things about atypical antidepressants is that it is given for seasonal patterns of depression. Wellbutrin is a well-known atypical antidepressant that is commonly prescribed to be taken in the fall months and is weaned off in the spring. Clients must be advised that this drug should be taken at night.

Indicators of Effectiveness

As the nurse in charge of a clinically depressed client, how would you answer the following questions?

  • How do I know if the medications are working or if they’re not?
  • How would I know if I’m getting better or getting worse?

You can effectively address the questions above by evaluating the client with the following indicators:

  1. The client will verbalize that he or she is in a good mood; signs of depression are no longer apparent.
  2. The client performs activities of daily living (ADLs) like getting dressed, having proper hygiene, etc.
  3. The client sleeps well.
  4. The client manifests improved eating habits which are evident in their weight (not too fat, not too skinny).
  5. The client has better social interaction or what is known as your therapeutic milieu principle.

Anticholinergic Effects

The last thing that you have to watch-out-for in clients taking antidepressants is the anticholinergic side effects. Nearly all the antidepressant medications have anticholinergic properties that cause clients to become dry or dehydrated.

What are some of the nursing interventions for these anticholinergic side effects?

  1. Instruct your clients to chew gum to trigger saliva production.
  2. Tell your clients to wear sunglasses to prevent photosensitivity due to dry eyes.
  3. Increase water consumption. Humans are 60% water, which is why you have to make sure that your client will maintain that level of fluid flowing inside the body to avoid dehydration.
  4. Tell your clients to pee before taking antidepressants to prevent urine retention.

So, these are the essential information that you need to know with regards to educating clients who are taking specific types of antidepressant medicine. These are condensed versions of lengthy, bulky books that tackle complicated psychiatric pharmacology subjects.

In our next videos and articles, we will discuss further topics and questions that usually come out of major nursing exams, especially during the NCLEX®. Check out our other nursing lectures by dropping by our SimpleNursing YouTube channel and website.

See you there!

Tricyclic Antidepressants Pharm: Brush Up on TCAs Pt 1

Tricyclic antidepressants (TCA) are one of the most significant lectures that you will encounter in your psychiatric nursing course. TCAs are just one of the leading antidepressants that will be discussed elaborately by Mike here at SimpleNursing.com.

After going through TCAs, we will also have separate videos for SSRs, MAOIs, and atypical antidepressants. Let’s get into it.

First Things First

Before going into the nitty-gritty details of TCAs, you first need to start with the pathophysiology. Things will not make sense if you have no idea about the pathophysiology. We’ve provided a 10-minute video on the introduction of pathophysiology so you can check that out to have a quick review before you go into your different medications.

Tricyclic Antidepressants – Description

Your first generation anti-depressant is your tricyclic antidepressants (TCA). You can easily remember TCAs as a Transportation Security Administration (TSA) – slow, drawn out, and the security process lags. Comparing it to TCAs, the therapeutic process is prolonged, taking a few weeks to a month. So, that’s the first thing to keep in mind:

            TCA = TSA = slow therapeutic range

What are the different types of TCAs?

  1. Amitriptyline (Elavil)
  2. Imipramine (Tofranil)
  3. Doxepin (Sinequan)

We’ve underlined Imipramine (Tofranil) just to emphasize that this drug is the most common TCA that you will encounter on your tests and in the clinical setting.

Test tip: Write this down on a notecard together with your pathophysiology of dopamine, serotonin, and norepinephrine. 

Tricyclic Antidepressants – Pathophysiology

There’s a block in the re-uptake of your norepinephrine and serotonin. Meaning, we are slowing down communication between neurons, thereby prolonging the neurotransmitters. Think of it as one side of a phone call is being delayed or put on hold from the other line to slow down the transmission of messages. Technically, we are blocking the re-uptake transmitters.

Norepinephrine (Levophed) is the catecholamine that helps in increasing the heart rate and blood pressure.

When TCAs are given, you are slowing down norepinephrine communication which is basically telling the body not to activate the heart severely and not squeeze those vessels that cause increased blood pressure.

Tricyclic Antidepressants – Side Effects

The main side effects of TCAs are:

  • Heart dysrhythmias
  • Hypotension
  • Anti-cholinergic effects like dryness
  • Confusion
  • Memory loss
  • Sedation

In cases of TCA toxicity, your client will be experiencing toxicity level signs and symptoms known as EPSE or extra-pyramidal side effects. The EPSE of TCA are:

  • Tardive dyskinesia
  • Akinesia
  • Akathisia
  • Pseudoparkinsonism

Note: There is a separate video dedicated to the thorough discussion of EPSEs. So, we recommend you watch that video to get a better understanding of the aforementioned EPSEs because they are also NCLEX® question favorites.

Tricyclic Antidepressants – Client Education

It is imperative to lay out all the facts on clients taking TCAs and to their caregiver or support system as well. What are the things that you need to educate and emphasize?

  1. TCA = slow acting (six to eight weeks for maximum therapeutic levels)
  2. Suicide ideations = essentially important to monitor because it usually happens in the first month of clients taking anti-depressants

Suicide ideations are not just for your TCAs but all the other antidepressant medications as well.

Big NCLEX® question for TCA:

Q: If your clients are feeling better and want to go home, what are you going to watch out for?

A: Suicide ideations.

If your answer is discharge planning, then that would be a big no-no.

Suicide ideations are the best answer because when major depressive clients feel better, technically they are still depressed, but with more energy.

During the major depression, clients do not feel like doing anything but sit like a lump on a log; they just don’t have the power to engage in any activity. However, after taking TCAs, depressed clients have enough energy to carry out thoughts of killing themselves.

Remember: Monitor for suicide ideations.

  1. Clients will have dry mouth and eyes, and their appetite is affected. Furthermore, clients will have low blood pressure.
  2. Clients will have orthostatic changes – sitting up then immediately passing out.
  3. No cardiac medications and no myocardial infarction or heart attack clients due to the involvement of norepinephrine.
  4. Wean off.

That’s it for your TCAs. On our next video, we will be discussing SSRIs.

See you there!