Major depressive disorder is a subtle mental disorder that makes an individual to experience depression, anxiety, insomnia, suicidal thoughts, lack of appetite, and lose interest in activities amongst other symptoms. Since anxiety and depression are among the major symptoms, the pharmacological management strategy is the use of fluoxetine, which reduces depressive moods among patients with major depressive disorder (Stewart, 2011). Fluoxetine is an antidepressant that belongs to the class of selective serotonin reuptake inhibitors (Lehne, 2012). As a subtle mental disorder, major depressive disorder affects mainly the young adults in the general population. According to Ferrari et al. (2013), 298 million people across the world suffer from major depressive disorder with high incidences occurring among young adults and women of ages between 25 and 34 years. These statistics indicate that the young adults and women have a higher risk of major depressive disorder than the general population. The two major non-pharmacological management strategies are psychotherapy and electrotherapy. According to McClintock, Brandon, Husain, and Jarrett (2011), psychotherapy techniques such as cognitive behavioral therapy and interpersonal therapy coupled with electroconvulsive therapy are effective in the management of depression. Therefore, the research paper examines an antidepressant called fluoxetine (prozac) and the nature of the implications it presents to nursing practice.
Description and Mechanism of Action
Fluoxetine is a selective serotonin reuptake inhibitor, which is effective in the treatment of major depressive disorder. As pharmacodynamics, the absorption of fluoxetine is fast because peak levels in plasma occur at about 6 to 8 hours after administration (Medsafe, 2012). Given that the route of administration is oral, interaction of fluoxetine with food slows down the rate of absorption, but systemic bioavailability remains the same. According to Ferrari et al. (2013), in distribution, fluoxetine binds to the plasma proteins such as glycoprotein and albumin. Vallerand and Sanoski (2012) explain that fluoxetine binds to the plasma proteins, which transport it to the brain, where it crosses the blood brain barrier and causes desired pharmacological effects. After its use in the brain, the plasma proteins transport fluoxetine to the liver, where the cytochrome P450 system and the CYP2D6 isoenzymes metabolize it, and subsequently excrete it through the kidneys (Vallerand & Sanoski, 2012).
In elucidating the mode of action, pharmacodynamics indicates that fluoxetine inhibits reuptake of serotonin by the nerve cells in the brain and central nervous systems; hence, increasing the concentration of serotonin around the nerve cells. Since the imbalances of neurotransmitters in the brain contribute to the occurrence of major depressive disorder, the accumulation of serotonin is beneficial as it restores the imbalances. Lehne (2012) argues that selective serotonin reuptake inhibitors act by preventing nerve cells from re-absorbing serotonin and thus causing its levels to increase in the brain. In this view, fluoxetine increases the levels of serotonin in the brain and therefore, restores the imbalances of neurotransmitters (Vallerand & Sanoski, 2012). Fluoxetine does not only treat major depressive disorder, but it has secondary uses in the treatment of related mental disorders. According to Medsafe (2014), fluoxetine treats premenstrual dysphoric disorder, obsessive-compulsive disorder, and bulimia nervosa.
Administration
The route of administration of fluoxetine, which is the selective serotonin reuptake inhibitor, is oral. According to Medsafe (2014), fluoxetine has a safe dosing range of 20 mg/day to 80 mg/day with a half-life of one to three days and four to six days for acute and chronic administration respectively. This means that fluoxetine has a long duration of action as active components persist for several weeks in the body. According to Lehne (2012), the length of therapy varies from four to nine months, depending on the severity of the depression. One can take fluoxetine either with or without meals because the meals merely delay the rate of absorption, but they have no effect on the pharmacokinetics and pharmacodynamics (Medsafe, 2014). The medical practitioner determines effectiveness of fluoxetine by assessing parameters such as the levels of depressive mood, anxiety, interests, and feelings. Hamilton Rating Scale effectively assesses and monitors efficacy of fluoxetine in the treatment of major depressive disorder (Luo, Chen, Li, Zhang, & Zhang, 2013).
Safety
The use of fluoxetine is not safe for pregnant women because it has adverse effects. Fluoxetine has the potential of causing cardiac abnormalities, pulmonary hypertension, and adaptation difficulties among neonates, as well as causing preterm birth (Stewart, 2011). In this view, clinicians and nurses should assess the conditions of the patients before they prescribe fluoxetine to them. The use of fluoxetine is unsafe for adults because it predisposes them to bone fractures, gastrointestinal bleeding, and hyponatremia. Common adverse reactions are serotonin syndrome, enhanced suicidal risk, sexual dysfunction, and weight gain (Lehne, 2012). Concerning contraindications, there are individuals who are hypersensitive to fluoxetine. Moreover, Medsafe (2014) argues that the interaction of fluoxetine and monoamine oxidase inhibitors causes serotonin syndrome and thus advises nurses not to use them at the same time or within a period of two weeks.
Patient Education
For nurses and clinicians to enhance safety and efficacy of fluoxetine, patients require education. Patients with major depressive disorder should understand that fluoxetine effect takes a long period of about one to three weeks; therefore, they should be patient (Medsafe, 2014). Additionally, the patients should continue taking fluoxetine for recommended period, which usually ranges from four to nine months, even if they feel fine in the meantime (Lehne, 2012). As antidepressants impair judgment, patients taking fluoxetine should not operate machines or drive vehicles. Regarding side effects, patients need to inform physicians or nurses if they are taking any medications or alcohol, breastfeeding, and pregnant so that they can receive appropriate advice, medication, and dosage (Vallerand & Sanoski, 2012). The patients should contact their physicians if they experience rashes and other adverse health effects of fluoxetine. The supply of 20 mg of fluoxetine for a period of one month has an average cost of $50. Fluoxetine is available in retail stores with a monthly retail price of $4 (Walmart, 2013).
Implications for Nursing Practice
The use of fluoxetine has significant implications for nursing practice because it has side effects among the patients. Since the side effects vary from one patient to another, depending on hypersensitivity, pregnancy, age, and drug interactions, nurses should be critical in assessing the safety fluoxetine among diverse types of patients (Stewart, 2011). The subtlety of the side effects requires nurses to monitor closely the occurrence of serotonin syndrome, suicidal ideation, sexual dysfunction, and weight gain amongst other adverse effects. Concerning therapeutic effects, fluoxetine has gradual therapeutic effects, which patients can mistake for its inefficacy (Medsafe, 2014). Eventually, the gradual effects temporarily stabilize the imbalances of neurotransmitters and give a false impression of healing in the meantime, before the completion of the period of therapy (Lehne, 2011). In this case, nurses should advise patients appropriately to increase fluoxetine adherence and prevent the relapse of major depressive disorder (Stewart, 2011).
References
Ferrari, A., Charlson, F., Norman, R., Flaxman, A., Patten, S., Vos, T., &Whiteford, H. (2013). The Epidemiological Modelling of Major Depressive Disorder: Application for the Global Burden of Disease Study 2010. PLOS ONE, 8(7), 1-14.
Lehne, R. (2012). Pharmacology for nursing care (8thed.). New York: Elsevier Health Sciences.
Luo, L., Chen, X., Li, H., Zhang, M., & Zhang, N. (2013). A distinct pattern of memory and attention deficiency in patients with depression. Chinese Medical Journal, 126(6), 1144-1149.
McClintock, M., Brandon, R., Husain, M., & Jarrett, B. (2011). A systemic review of the combined use of electroconvulsive therapy and psychotherapy for depression. The Journal of ECT, 27(3), 236-243.
Medsafe (2014). Fluoxetine-AFT. Web.
Stewart, D. (2011). Depression during pregnancy. The New England Journal of Medicine, 365(17), 1506-1611.
Vallerand, A., & Sanoski, C. (2012). Davis’s drug guide for nurses. Philadelphia: F.A. Davis Company.
Walmart (2013). Retail Prescription Program Drug List. Web.