Escitalopram

INTRODUCTION

Indications

Major depressive disorder. Generalized anxiety disorder (GAD). Unlabeled Use: Panic disorder. Obsessive-compulsive disorder (OCD). Posttraumatic stress disorder (PTSD). Social anxiety disorder (social phobia). Premenstrual dysphoric disorder (PMDD).

Action

Selectively inhibits the reuptake of serotonin in the CNS. Therapeutic Effects: Antidepressant action.

Adverse Reactions/Side Effects

CNS: insomnia, dizziness, drowsiness, fatigue. GI: diarrhea, nausea, abdominal pain, constipation, dry mouth, indigestion. GU: anorgasmia, decreased libido, ejaculatory delay, erectile dysfunction. Derm: increased sweating. Endo: syndrome of inappropriate secretion of antidiuretic hormone (SIADH). F and E: hyponatremia. Metab: increased appetite.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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 or other changes in mood and behavior.

• 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.

• Monitor signs of fluid-electrolyte imbalance due to SIADH and hyponatremia. 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.

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

Interventions

• Help patient explore nonpharmacologic methods such as exercise, counseling, and support groups to help reduce depression, anxiety, and other mood disorders

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 and other CNS depressants because of the increased risk of sedation and adverse effects.

• Advise patient that GI problems may occur, and to report severe or prolonged nausea, diarrhea, constipation, abdominal pain, dry mouth, or indigestion.

• Instruct patient to report other troublesome side effects such as severe or prolonged sleep loss, increased sweating, or changes in sexual function (decreased libido, erectile dysfunction, ejaculatory problems).

Pharmacokinetics

Absorption: 80% absorbed following oral administration.

Distribution: Enters breast milk.

Metabolism and Excretion: Mostly metabolized by the liver (primarily CYP3A4 and CYP2C19 isoenzymes); 7% excreted unchanged by kidneys.

Half-life: Increased in geriatric patients and patients with hepatic impairment.