ASNA Independent Study Activity

Alabama Nurse,  Jun-Aug 2004  by Johnson, Michael R

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Selective Serotonin Reuptake Inhibitors (SSRIs) - What Nurses Should Know

Objectives: At the conclusion of this activity the participant should be able to:

1. Summarize the potential side effects of a patient taking SSRIs.

2. Restate medications that may cause a synergistic reaction with SSRIs.

3. List at least three (3) uses for SSRIs.

Directions: Read the article carefully. Return the answer sheet printed at the end of the article (page 27) and fill out all sections carefully. Mail to the address provided along with the appropriate fee. Certificates will be mailed upon successful completion of the post-test and completion of the evaluation. You must score at least 75%. Should you fail the test you will be notified and offered an opportunity to retake the test. all retakes will require an additional fee.

Contact Hour and Accreditation: This 1.5 contact hour activity is provided by the Alabama Sate Nurses Association, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center (ANCC) and the Alabama Board of Nursing.

Introduction: SSRIs are currently among the most common prescribed antidepressant medications. As such, it is critical for nurses to be knowledgeable about indications, drug interactions, expected effects, and side effects of these medications.

Recently, a great deal of controversy has surrounded the use of SSRIs. For that reason, this article will, for the most part, avoid the mention of specific SSRI drugs by name; instead they will be referenced as a group. The controversy involves possible suicidal behavior in clients being treated with these drugs. The following are important points for consideration.

Several years ago the initial member of this group, fluoxetine (Prozac), was accused of causing an increased incidence of suicidal behavior. It is acceptable to mention this drug because it has since been vindicated by research. The rate of suicidal behavior is the same with fluoxetine (Prozac) as compared to other antidepressants. Interviews with several psychiatrists on this subject indicate a consensus of opinion that the vast majority of SSRI prescriptions are written by non-mental health practitioners and administered in non-structured situations with inadequate follow up. These factors, combined with the known suicidal component of major depression could account for the observed incidence of suicide.

Secondly, in assessing the clients who are on these medications, nurses must evaluate their client's level of suicidal ideation and make note of any recent uncharacteristic changes in mood and behavior, which may indicate increased risk. If this occurs in an outpatient setting, hospitalization of the client may be indicted. A bright spot is the fact that these medications are much less toxic than drugs previously utilized for depression. Therefore, few clients will have enough medication on hand to successfully commit suicide.

Finally this matter is currently being researched and will ultimately be closely reviewed by the FDAf(Federal Drug Administration). Until the research findings are validated, the best interventions seem to be education of both clients and professionals as well as diligent observation and follow-up.

Nursing Management - Basically, the SSRIs accomplish their effect by inhibiting the reuptake of serotonin (a neurotransmitter necessary for normal mood) at the synapse level. Reuptake of serotonin into the neuron is the first step in the catabolism of this substance. The next step is the breakdown of the substance by the enzyme known as monoamine oxidase. By slowing the catabolic process, the SSRIs theoretically increase the available supply of serotonin at the synapse level thus increasing the supply of serotonin.

It is useful to review an earlier class of antidepressants, the Monamine Oxidase Inhibitors (MAOIs), which accomplish their effect by inhibiting monamine oxidase. Using MAOIs result in an increased availability of CNS norepinephrine and serotonin at the synaptic level. Due to some dangerous side effects, MAOIs are seldom used today. It is also not considered safe to administer MAOIs -along with SSRIs without a two-week "washout" period (discontinuance of a drug before administration of the other).

As a rule, SSRIs take approximately three weeks before a therapeutic effect is noted. These positive effects may continue to accrue for up to six weeks. The client will then know how much benefit will be gained from the drug. At .

that time, if' sufficient relief has not been achieved, the physician may adjust the dose, or possibly change the drug. It is important for clients to know that these drugs have to be taken regularly, in order to be effective. It is not possible to skip dosages on "good" days and expect them to perform adequately. It is also important to avoid consuming alcohol and street drugs, i.e. crack, ecstasy, etc. while taking these meds.

Medication Side Effects - Most physicians generally prescribe antidepressants medications for six months to a year for the first episode of depression and then discontinue the drug. However, if the person has two or more episodes of depression the medication is usually continued for life. While therapeutic effects take time to occur, side effects often happen immediately. This is one argument for beginning these medicines in an inpatient setting. Side effects commonly include the following: nausea, vomiting, headaches, anxiety, insomnia, nightmares, weight loss or gain, restlessness, dizziness, drowsiness and dry mouth. Other more unusual, but equally disturbing side effects include alterations in perception of temperature (i.e., feeling too hot or cold), which can be accompanied by seating or piloerection and bouts of frequent yawning occur occasionally. Pseudoparkinsonism, similar to that, which occurs with the use of antipsychotics, occurs on very rare occasions. Sexual side effects can have a significant negative impact on medication compliance. Individuals, particularly men, on SSRIs may stop taking the drug because they may have greater difficulty achieving orgasm and/or become impotent.