Vilazodone

INTRODUCTION

Indications

Treatment of major depressive disorder.

Action

↑ serotonin activity in the CNS by inhibiting serotonin reuptake. Therapeutic Effects: Improvement in symptoms of depression.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT-LIKE SYNDROME, SEIZURES, SUICIDAL THOUGHTS, insomnia, abnormal dreams, dizziness. GI: diarrhea, nausea, dry mouth, restlessness, vomiting. Endo: ↓ libido, sexual dysfunction, syndrome of inappropriate antidiuretic hormone (SIADH). F and E: hyponatremia. Hemat: bleeding. Misc: SEROTONIN SYNDROME.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Watch for signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use. Report these signs to the physician immediately.

• Monitor and immediately report signs of serotonin syndrome, including hyperthermia, rigidity, myoclonus, and autonomic instability with fluctuating vital signs and extreme agitation that may proceed to delirium and coma. Patients should not take vilazodone with other drugs that increase serotonin levels (e.g., MAO inhibitors).

• 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.

• Watch for signs of bleeding, such as bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure. Notify physician immediately if these signs occur.

• Monitor signs of fluid-electrolyte imbalance due to syndrome of inappropriate antidiuretic hormone (SIADH). SIADH causes increased water retention that leads to relatively low sodium concentration (hyponatremia). Symptoms include confusion, lethargy, weakness, myoclonus, and depressed reflexes. Severe or sudden onset may also cause seizures, ataxia, nystagmus, tremor, dysarthria, dysphagia, and coma. Notify physician if these signs occur.

• Assess dizziness 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.

Interventions

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

• Help patient explore nonpharmacological methods reduce depression and other psychologic disorders (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 ...