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Antidepressants & Mood Stabilizers
Answers & Rationale
Question 1
Correct Answer: A. Beginning to down-taper the amitriptyline
Rationale:
Why A is correct: Tricyclic antidepressants (TCAs) like amitriptyline
typically show therapeutic effects within 2-4 weeks. After 6 weeks
with no improvement, the medication should be gradually withdrawn
(to avoid withdrawal symptoms) and an agent from another class
(e.g., SSRI) prescribed.
Why B is wrong: TCAs cause sedation and should be taken at
bedtime; changing to morning dosing would increase daytime
drowsiness without improving efficacy.
Why C is wrong: Once-daily dosing is standard; splitting the dose
would not improve efficacy and would increase side effects during
the day.
Why D is wrong: If there is no response after 6 weeks, increasing the
dose is unlikely to help and may increase toxicity.
Clinical judgment: The nurse should recognize treatment failure and
advocate for a medication change rather than dose escalation.
Question 2
Correct Answer: D. “I will take the medication in the morning before
breakfast.”
Rationale:
Why D indicates need for further teaching: Doxepin is a TCA that
causes significant sedation and drowsiness. It should be taken at
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bedtime, not in the morning, to minimize daytime impairment and
fall risk.
Why A is correct (shows understanding): TCAs typically take 2-4
weeks for full antidepressant effect.
Why B is correct: TCAs cause constipation due to anticholinergic
effects; increasing fluids and fiber is appropriate.
Why C is correct: TCAs cause orthostatic hypotension; rising slowly
prevents dizziness and falls.
Clinical judgment: The nurse must correct the misconception about
dosing time to ensure safety and effectiveness.
Question 3
Correct Answer: A. Increase fluid intake.
Rationale:
Why A is correct: Constipation and dry mouth are common
anticholinergic side effects of TCAs. Increasing fluid intake helps
manage both symptoms and is a first-line non-pharmacologic
intervention.
Why B is wrong: These side effects are expected and not severe;
notifying the provider is unnecessary unless they become intolerable.
Why C is wrong: Switching antidepressants is not indicated for mild,
manageable side effects.
Why D is wrong: Abruptly stopping TCAs can cause withdrawal
symptoms (nausea, headache, insomnia) and relapse of depression.
Clinical judgment: The nurse should teach symptom management
strategies (sugar-free gum for dry mouth, fiber and fluids for
constipation).
Question 4
Correct Answer: A. It can be used after daily maintenance dosing proves
effective and safe.
Rationale:
Why A is correct: Once-weekly fluoxetine (90 mg) is approved for
maintenance therapy after the patient has responded to daily dosing
(20 mg/day) without serious adverse effects.
Why B is wrong: Weekly dosing is not dependent on a trial of TCAs;
it is an option for fluoxetine after daily stabilization.
Antidepressants & Mood Stabilizers
Answers & Rationale
Question 1
Correct Answer: A. Beginning to down-taper the amitriptyline
Rationale:
Why A is correct: Tricyclic antidepressants (TCAs) like amitriptyline
typically show therapeutic effects within 2-4 weeks. After 6 weeks
with no improvement, the medication should be gradually withdrawn
(to avoid withdrawal symptoms) and an agent from another class
(e.g., SSRI) prescribed.
Why B is wrong: TCAs cause sedation and should be taken at
bedtime; changing to morning dosing would increase daytime
drowsiness without improving efficacy.
Why C is wrong: Once-daily dosing is standard; splitting the dose
would not improve efficacy and would increase side effects during
the day.
Why D is wrong: If there is no response after 6 weeks, increasing the
dose is unlikely to help and may increase toxicity.
Clinical judgment: The nurse should recognize treatment failure and
advocate for a medication change rather than dose escalation.
Question 2
Correct Answer: D. “I will take the medication in the morning before
breakfast.”
Rationale:
Why D indicates need for further teaching: Doxepin is a TCA that
causes significant sedation and drowsiness. It should be taken at
, 2|Page
bedtime, not in the morning, to minimize daytime impairment and
fall risk.
Why A is correct (shows understanding): TCAs typically take 2-4
weeks for full antidepressant effect.
Why B is correct: TCAs cause constipation due to anticholinergic
effects; increasing fluids and fiber is appropriate.
Why C is correct: TCAs cause orthostatic hypotension; rising slowly
prevents dizziness and falls.
Clinical judgment: The nurse must correct the misconception about
dosing time to ensure safety and effectiveness.
Question 3
Correct Answer: A. Increase fluid intake.
Rationale:
Why A is correct: Constipation and dry mouth are common
anticholinergic side effects of TCAs. Increasing fluid intake helps
manage both symptoms and is a first-line non-pharmacologic
intervention.
Why B is wrong: These side effects are expected and not severe;
notifying the provider is unnecessary unless they become intolerable.
Why C is wrong: Switching antidepressants is not indicated for mild,
manageable side effects.
Why D is wrong: Abruptly stopping TCAs can cause withdrawal
symptoms (nausea, headache, insomnia) and relapse of depression.
Clinical judgment: The nurse should teach symptom management
strategies (sugar-free gum for dry mouth, fiber and fluids for
constipation).
Question 4
Correct Answer: A. It can be used after daily maintenance dosing proves
effective and safe.
Rationale:
Why A is correct: Once-weekly fluoxetine (90 mg) is approved for
maintenance therapy after the patient has responded to daily dosing
(20 mg/day) without serious adverse effects.
Why B is wrong: Weekly dosing is not dependent on a trial of TCAs;
it is an option for fluoxetine after daily stabilization.
