Pharmacologic: selective serotonin/norepinephrine reuptake inhibitors
Treatment of major depressive disorder, often in conjunction with psychotherapy.
Inhibits serotonin and norepinephrine reuptake in the CNS. Therapeutic Effects: Decrease in depressive symptomatology, with fewer relapses/recurrences.
Adverse Reactions/Side Effects
CNS: SEIZURES, anxiety, dizziness, drowsiness, insomnia, headache. EENT: ↑ intraocular pressure, mydriasis. Resp: eosinophilic pneumonia, interstitial lung disease. CV: hypertension. GI: ↓ appetite, constipation, nausea. GU: male sexual dysfunction. Derm: sweating. F and E: hyponatremia. Hemat: ↑ risk of bleeding. Metab: hypercholesterolemia, hyperlipidemia. Misc: serotonin syndrome.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.
Be alert for increased depression and suicidal thoughts, especially in the initial period of drug therapy, and in children and teenagers. Likewise, inform physician or mental health care professional if patient demonstrates other mood changes such as increased anxiety, nervousness, agitation, confusion, and emotional lability.
Monitor and report signs of serotonin syndrome, including hyperthermia, rigidity, myoclonus, and autonomic instability with fluctuating vital signs and extreme agitation which may proceed to delirium and coma. Patients should not take desvenlafaxine with other drugs that increase serotonin levels (e.g., MAO inhibitors).
Assess any breathing problems or signs of interstitial lung disease or eosinophilic pneumonia. Signs include cough, wheezing, chest pain, shortness of breath, fever, chills, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.
Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).
Be alert for signs of prolonged bleeding time such as bleeding gums, nosebleeds, and unusual or excessive bruising. Report these signs to the physician.
Monitor signs of low sodium levels (hyponatremia), including headache, confusion, lethargy, irritability, decreased consciousness, and neuromuscular abnormalities (muscle weakness and cramps). Report severe or prolonged signs to the physician.
Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall prevention strategies (See Appendix E).
Help patient explore nonpharmacologic methods (exercise, counseling, support groups, and so forth) to reduce depression and anxiety.