Antidepressants are among the most commonly prescribed psychiatric medications, and understanding them is essential for every registered nurse, especially those preparing for the NCLEX. Nurses play a vital role in patient assessment, medication education, safety monitoring, and early recognition of side effects. This guide explains the major antidepressant classes, their effects, and the key nursing responsibilities that should be included in any high-quality nursing bundle or study plan for RN nurses.
What Are Antidepressants?
Antidepressants are medications designed to treat depressive disorders, anxiety disorders, PTSD, OCD, and other mood-related conditions. While the primary goal is mood stabilization and improved functioning, these drugs also affect sleep, appetite, energy levels, and concentration.
For NCLEX success, nurses must know mechanisms of action, major side effects, black box warnings, and priority assessments.
Major Classes of Antidepressants
1. SSRIs — Selective Serotonin Reuptake Inhibitors
Examples: Fluoxetine, Sertraline, Escitalopram, Paroxetine, Citalopram
Mechanism: Increases serotonin levels by blocking reuptake.
Common Effects
- Improved mood and energy
- Increased appetite in some patients
- Better sleep (or insomnia at first)
Side Effects
- Sexual dysfunction
- Weight changes
- GI upset
- Headache
- Insomnia or sedation
Nursing Monitoring
- Watch for serotonin syndrome (agitation, hyperreflexia, fever, tremor).
- Assess for suicidal ideation—highest risk in the first weeks.
- Teach patients that full effect takes 4–6 weeks.
- Do not stop abruptly—risk of withdrawal symptoms.
- Review other serotonergic medications.
2. SNRIs — Serotonin-Norepinephrine Reuptake Inhibitors
Examples: Venlafaxine, Duloxetine, Desvenlafaxine
Mechanism: Increases serotonin and norepinephrine.
Common Effects
- Improved mood
- Increased energy and concentration
Side Effects
- Hypertension
- Headache
- Sweating
- Nausea
Nursing Monitoring
- Monitor blood pressure closely.
- Teach not to stop suddenly.
- Evaluate for anxiety or restlessness early in treatment.
3. TCAs — Tricyclic Antidepressants
Examples: Amitriptyline, Nortriptyline, Imipramine
Mechanism: Increases serotonin and norepinephrine.
Common Effects
- Sedation
- Pain relief (neuropathic pain)
Side Effects
- Anticholinergic effects (dry mouth, constipation, urinary retention)
- Orthostatic hypotension
- Cardiac dysrhythmias (high risk)
Nursing Monitoring
- Assess cardiac history—ECG before starting in many cases.
- Warn about sedation—take at night.
- Increase fiber and fluid to reduce constipation.
- Watch for overdose—TCAs are highly fatal in overdose situations.
4. MAOIs — Monoamine Oxidase Inhibitors
Examples: Phenelzine, Selegiline, Tranylcypromine
Mechanism: Prevent breakdown of serotonin, norepinephrine, dopamine.
Side Effects
- Orthostatic hypotension
- Anxiety
- Hypertensive crisis
Major Nursing Alert
Patients must avoid tyramine-rich foods, such as:
- Aged cheese
- Fermented meats
- Beer, wine
- Soy products
Nursing Monitoring
- Teach strict dietary restrictions.
- Monitor for severe headache → possible hypertensive crisis.
- Avoid other antidepressants; risk of serotonin syndrome or hypertensive crisis.
5. Atypical Antidepressants
Bupropion
- Stimulating
- Helps with smoking cessation
- Side effect: risk of seizures
- Do NOT give to patients with eating disorders.
Mirtazapine
- Sedating
- Causes weight gain
- Used for patients with insomnia or poor appetite
Nursing Responsibilities in Antidepressant Therapy
1. Baseline and Ongoing Assessments
Every RN nurse must document:
- Mood
- Sleep
- Appetite
- Suicidal thoughts
- Blood pressure (for SNRIs and TCAs)
- Weight changes
2. Patient Teaching (NCLEX Priority)
- Antidepressants take weeks to work.
- Never stop suddenly.
- Avoid alcohol due to CNS depression.
- Teach signs of serotonin syndrome.
- Promote safety when side effects cause dizziness or sedation.
3. Monitoring for Safety Risks
A high-alert role for the nurse includes:
- Increased risk of suicide during early treatment
- Hypertensive crisis with MAOIs
- Cardiac arrhythmias with TCAs
- Overstimulation with bupropion
4. Cultural and Emotional Support
Registered nurses must provide reassurance, validate feelings, and reinforce that medication is one part of a complete treatment plan, often combined with therapy, lifestyle changes, or coping strategies.
Conclusion
Understanding antidepressant classes and their effects is essential for safe practice and NCLEX readiness. Every registered nurse or RN nurse must be skilled in assessment, side-effect identification, patient education, and long-term monitoring. Whether you’re studying from a nursing bundle, preparing for an exam, or caring for real patients, these medication principles form the foundation of safe psychiatric nursing.
❓ FAQ
The NCLEX focuses heavily on SSRIs, SNRIs, TCAs, MAOIs, and atypical antidepressants. RN nurses must know their mechanisms, side effects, and safety alerts such as serotonin syndrome and hypertensive crisis.
Most antidepressants take 4–6 weeks to reach full therapeutic effect. Nurses should teach patients to continue taking the medication even if they do not feel better right away.
Serotonin syndrome occurs when serotonin levels become too high.
Symptoms: agitation, diaphoresis, fever, tremor, hyperreflexia.
It can be life-threatening, making early recognition a top NCLEX priority for RN nurses.
Patients must avoid tyramine-rich foods, such as aged cheese, cured meats, wine, beer, and fermented products. Tyramine can trigger a hypertensive crisis, a medical emergency.