Trimipramine

INTRODUCTION

Indications

Treatment of depression, often in conjunction with psychotherapy.

Action

Potentiates the effect of serotonin and norepinephrine in the CNS. Has significant anticholinergic properties, including sedation. Therapeutic Effects: Antidepressant action.

Adverse Reactions/Side Effects

CNS: lethargy, sedation. EENT: blurred vision, dry eyes, dry mouth. CV: ARRHYTHMIAS, hypotension, ECG changes. GI: constipation, hepatitis, paralytic ileus, increased appetite, weight gain. GU: urinary retention, ↓ libido. Derm: photosensitivity. Endo: changes in blood glucose, gynecomastia. Hemat: blood dyscrasias.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Watch for signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment or in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression.

• Monitor other alterations in mental status including lethargy and sedation. Notify physician if these symptoms become problematic.

• Watch for signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall prevention strategies (See Appendix E).

• Because of the risk of cardiac arrhythmias and abnormal BP responses, use caution during aerobic exercise and endurance conditioning. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

• Help patient explore nonpharmacologic methods to reduce depression (exercise, counseling, support groups, and so forth).

Patient/Client-Related Instruction

• Advise patient that antidepressant effects may not occur immediately; it may take 2 wk or more before an improvement in mood is observed.

• Advise patient to avoid alcohol ...