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Chamberlain College of Nursing
Antidepressant and Mood Stabilizer Medication
Table 1
Course: NR546/NR 546 Advanced
Pharmacology: Psychopharmacology
, Antidepressant Medications
Indication, starting dose, target Half-life (T1/2) Notes/Notable side effects/Precautions
Name symptoms, and affected CYP450 enzyme
neurotransmitters
SSRIs
Citalopram serotonin reuptake inhibitor Parent drug has Notable Side Effects Sexual dysfunction (dose-dependent; men:
(Celexa) (S-RI) 23–45 hour half- delayed ejaculation, erectile, dysfunction; men and women:
life decreased sexual desire, anorgasmia) Gastrointestinal
Commonly Prescribed for Weak inhibitor of (decreased appetite, nausea, diarrhea, constipation, dry
Depression Premenstrual CYP450 2D6 mouth) Mostly CNS (dose-dependent insomnia but also
dysphoric disorder (PMDD) Metabolized by sedation, agitation, tremors, headache, dizziness) Activation
Obsessive-compulsive disorder CYP450 3A4 and (short-term; patients with diagnosed or undiagnosed bipolar or
(OCD) Panic disorder 2C19 psychotic disorders may be more vulnerable to CNS-activating
Generalized anxiety disorder actions of SSRIs) Sweating (dose-dependent) Bruising and rare
(GAD) Posttraumatic stress bleeding Rare hyponatremia (mostly in elderly patients and
disorder (PTSD) Social anxiety generally reversible on discontinuation of citalopram) SIADH
disorder (social phobia) (syndrome of inappropriate antidiuretic hormone secretion)
The goal of treatment is Other Warnings/Precautions Use with caution in patients with
complete remission of current history of seizures Use with caution in patients with bipolar
symptoms as well as disorder unless treated with concomitant mood-stabilizing
prevention of future relapses agent When treating children, carefully weigh the risks and
benefits of pharmacological treatment against the risks and
How to Dose Initial 20 mg/day; benefits of nontreatment with antidepressants and make sure
increase by 20 mg/day after 1 to document this in the patient’s chart. Whenever possible,
or more weeks; maximum 40 warn patients and their caregivers about the possibility of
mg/day; single-dose activating side effects, and advise them to report such
administration, morning or symptoms immediately. Monitor patients for activation of
evening suicidal ideation, especially children and adolescents
Escitalopram SSRI (selective serotonin Mean terminal Notable Side Effects Sexual dysfunction (men: delayed
(Lexapro) reuptake inhibitor half-life 27–32 ejaculation, erectile dysfunction; men and women: decreased
hours sexual desire, anorgasmia) Gastrointestinal (decreased
Commonly Prescribed for Substrate for appetite, nausea, diarrhea, constipation, dry mouth) Mostly
, Major depressive disorder CYP450 2C19 and central nervous system (insomnia but also sedation, agitation,
(ages 12 and older) 3A4 No tremors, headache, dizziness) Note: patients with diagnosed or
Generalized anxiety disorder significant undiagnosed bipolar or psychotic disorders may be more
(GAD) Panic disorder actions on vulnerable to CNS-activating actions of SSRIs Autonomic
Obsessive-compulsive disorder CYP450 enzymes (sweating). Bruising and rare bleeding Rare hyponatremia
(OCD) Posttraumatic stress (mostly in elderly patients and generally reversible on
disorder (PTSD) Social anxiety discontinuation of escitalopram SIADH (syndrome of
disorder (social phobia) inappropriate antidiuretic hormone secretion)
Premenstrual dysphoric
disorder (PMDD Other Warnings/Precautions
Use with caution in patients with history of seizures Use with
Boosts neurotransmitter caution in patients with bipolar disorder unless treated with
serotonin Blocks serotonin concomitant mood-stabilizing agent
reuptake pump (serotonin When treating children, carefully weigh the risks and benefits
transporter) Desensitizes of pharmacological treatment against the risks and benefits of
serotonin receptors, especially nontreatment with antidepressants and make sure to
serotonin 1A autoreceptors document this in the patient’s chart
Whenever possible, warn patients and their caregivers about
Treatment most often reduces the possibility of activating side effects, and advise them to
or even eliminates symptoms, report such symptoms immediately Monitor patients for
but not a cure since symptoms activation of suicidal ideation, especially children and
can recur after medicine adolescents
stopped
Initial 10 mg/day; increase to
20 mg/day if necessary; single-
dose administration, morning
or evening
Fluoxetine SSRI (selective serotonin Active Notable Side Effects Sexual dysfunction (men: delayed
(Prozac) reuptake inhibitor metabolite ejaculation, erectile dysfunction; men and women: decreased
(norfluoxetine) sexual desire, anorgasmia) Gastrointestinal (decreased
Commonly Prescribed for has 2 week half- appetite, nausea, diarrhea, constipation, dry mouth) Mostly
Major depressive disorder life Parent drug CNS (insomnia but also sedation, agitation, tremors, headache,
(ages 8 and older) Obsessive- has 2–3 day half- dizziness). Note: patients with diagnosed or undiagnosed
Chamberlain College of Nursing
Antidepressant and Mood Stabilizer Medication
Table 1
Course: NR546/NR 546 Advanced
Pharmacology: Psychopharmacology
, Antidepressant Medications
Indication, starting dose, target Half-life (T1/2) Notes/Notable side effects/Precautions
Name symptoms, and affected CYP450 enzyme
neurotransmitters
SSRIs
Citalopram serotonin reuptake inhibitor Parent drug has Notable Side Effects Sexual dysfunction (dose-dependent; men:
(Celexa) (S-RI) 23–45 hour half- delayed ejaculation, erectile, dysfunction; men and women:
life decreased sexual desire, anorgasmia) Gastrointestinal
Commonly Prescribed for Weak inhibitor of (decreased appetite, nausea, diarrhea, constipation, dry
Depression Premenstrual CYP450 2D6 mouth) Mostly CNS (dose-dependent insomnia but also
dysphoric disorder (PMDD) Metabolized by sedation, agitation, tremors, headache, dizziness) Activation
Obsessive-compulsive disorder CYP450 3A4 and (short-term; patients with diagnosed or undiagnosed bipolar or
(OCD) Panic disorder 2C19 psychotic disorders may be more vulnerable to CNS-activating
Generalized anxiety disorder actions of SSRIs) Sweating (dose-dependent) Bruising and rare
(GAD) Posttraumatic stress bleeding Rare hyponatremia (mostly in elderly patients and
disorder (PTSD) Social anxiety generally reversible on discontinuation of citalopram) SIADH
disorder (social phobia) (syndrome of inappropriate antidiuretic hormone secretion)
The goal of treatment is Other Warnings/Precautions Use with caution in patients with
complete remission of current history of seizures Use with caution in patients with bipolar
symptoms as well as disorder unless treated with concomitant mood-stabilizing
prevention of future relapses agent When treating children, carefully weigh the risks and
benefits of pharmacological treatment against the risks and
How to Dose Initial 20 mg/day; benefits of nontreatment with antidepressants and make sure
increase by 20 mg/day after 1 to document this in the patient’s chart. Whenever possible,
or more weeks; maximum 40 warn patients and their caregivers about the possibility of
mg/day; single-dose activating side effects, and advise them to report such
administration, morning or symptoms immediately. Monitor patients for activation of
evening suicidal ideation, especially children and adolescents
Escitalopram SSRI (selective serotonin Mean terminal Notable Side Effects Sexual dysfunction (men: delayed
(Lexapro) reuptake inhibitor half-life 27–32 ejaculation, erectile dysfunction; men and women: decreased
hours sexual desire, anorgasmia) Gastrointestinal (decreased
Commonly Prescribed for Substrate for appetite, nausea, diarrhea, constipation, dry mouth) Mostly
, Major depressive disorder CYP450 2C19 and central nervous system (insomnia but also sedation, agitation,
(ages 12 and older) 3A4 No tremors, headache, dizziness) Note: patients with diagnosed or
Generalized anxiety disorder significant undiagnosed bipolar or psychotic disorders may be more
(GAD) Panic disorder actions on vulnerable to CNS-activating actions of SSRIs Autonomic
Obsessive-compulsive disorder CYP450 enzymes (sweating). Bruising and rare bleeding Rare hyponatremia
(OCD) Posttraumatic stress (mostly in elderly patients and generally reversible on
disorder (PTSD) Social anxiety discontinuation of escitalopram SIADH (syndrome of
disorder (social phobia) inappropriate antidiuretic hormone secretion)
Premenstrual dysphoric
disorder (PMDD Other Warnings/Precautions
Use with caution in patients with history of seizures Use with
Boosts neurotransmitter caution in patients with bipolar disorder unless treated with
serotonin Blocks serotonin concomitant mood-stabilizing agent
reuptake pump (serotonin When treating children, carefully weigh the risks and benefits
transporter) Desensitizes of pharmacological treatment against the risks and benefits of
serotonin receptors, especially nontreatment with antidepressants and make sure to
serotonin 1A autoreceptors document this in the patient’s chart
Whenever possible, warn patients and their caregivers about
Treatment most often reduces the possibility of activating side effects, and advise them to
or even eliminates symptoms, report such symptoms immediately Monitor patients for
but not a cure since symptoms activation of suicidal ideation, especially children and
can recur after medicine adolescents
stopped
Initial 10 mg/day; increase to
20 mg/day if necessary; single-
dose administration, morning
or evening
Fluoxetine SSRI (selective serotonin Active Notable Side Effects Sexual dysfunction (men: delayed
(Prozac) reuptake inhibitor metabolite ejaculation, erectile dysfunction; men and women: decreased
(norfluoxetine) sexual desire, anorgasmia) Gastrointestinal (decreased
Commonly Prescribed for has 2 week half- appetite, nausea, diarrhea, constipation, dry mouth) Mostly
Major depressive disorder life Parent drug CNS (insomnia but also sedation, agitation, tremors, headache,
(ages 8 and older) Obsessive- has 2–3 day half- dizziness). Note: patients with diagnosed or undiagnosed
