Bupropion antidepressants
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Buproprion
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Acts by inhibiting norepinephrine and dopamine uptake, and is referred to as a norepinephrine-dopamine reuptake inhibitor.
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Treatment for depression
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Alternative to SSRIs and SNRIs for clients unable to tolerate sexual dysfunction adverse effects of these antidepressants
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Aid for smoking cessation
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Prevention of seasonal pattern depression
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Alternative treatment choice for attention-deficit disorder
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Complication
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Nursing Action and Education
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Headache, dry mouth, GI distress, Constipation, Increased heart rate, Hypertension, Restlessness, and Insomnia
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Treat headache with mild analgesic. Observe for effects and notify the provider if intolerable. Sip on fluids to treat dry mouth and increase dietary fiber to prevent constipation.
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Nausea, Vomiting, Anorexia, Weight Loss
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Monitor weight and food intake
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Seizures
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Avoid administering to clients at risk for seizures (a client who have head injuries). Monitor for seizures, and treat accordingly.
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Bupropion is a pregnancy risk category B.
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Notify the provider if pregnant or breastfeeding. The provider will determine is the risks of taking the medication out-weigh the benefiits.
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Contraindicated in clients taking MAOIs.
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Contraindicated for clients who have seizure disorders or eating disorders.
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Interaction
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Nursing Action
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MAOIs (phenelzine) increase the risk for toxicity
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MAOIs should be discontinued 2 weeks prior to beginning treatment with bupropion.
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Mirtazapine
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Referred to as a serotonin-norepinephrine disinhibitor.
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It increases the release of serotonin and norepinephrine by blocking the presynaptic receptors, and thereby increases thee amount of neurotransmitters available for impulse transmission.
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Therapeutic effects can occur sooner with less sexual dysfunction than with SSRIs
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Mirtazapine is generally well tolerated. Clients can experience sleepiness that can be exacerbated by other CNS depressants (alcohol, benzodiazepines), weight gain, and elevated cholesterol.
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Take at bedtime, can be used as sleep aid.
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Vilazodone
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Both blocks serotonin and works with a serotonin agonist at receptor site (first medication to work in this way).
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Contraindicated with SSRIs and SNRIs (serotonin syndrome), and other serotonin receptor agonists (buspirone and phenothiazines). Stop MAOIs at least 14 days before starting vilazodone.
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Teach manifestations of serotonin syndrome to client and instruct them when to notify provider.
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Monitor for sucidal ideation
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Many adverse effects are similar to those of SSRIs and SNRIs.
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Take with food to help increase absorption.
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Avoid grapefruit juice while taking Vilazodone because grapefruit juice inhibits CYP3A4 metabolism resulting in an increase in the medication blood level.
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Nefazodone
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Selectively inhibits the reuptake of serotonin and norepinephrine.
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Rapidly absorbed in 1 hr when taken without food.
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Adverse effects are sleepiness, headache, dizziness, blurred vision, dry mouth, nausea, constipation, weight gain, and sexual dysfunction
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Stop MAOIs at least 14 days before starting nefazodone.
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Trazodone ER
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Moderate selective blockage of serotonin receptors, which allows more serotonin to be available for impulse transmission.
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Usually used with another antidepressant agent.
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Sedation is a potential problem, can be indicated for a client who has insomnia.
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Priapism is a potential adverse effect. Instruct clients to seek medical attention immediately if this occurs
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Don't drink grapefruit juice as it inhibits CYP3A4 metabolism resulting in an increase in the medication blood level resulting in toxicity.
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