Patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, "I stopped taking my antidepressant 2 days ago
Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares." The nurse should advise the patient:
a. "Go to the nearest emergency department immediately."
b. "Do not to be alarmed. Take two aspirin and drink plenty of fluids."
c. "Take one dose of the antidepressant. Come to the clinic to see the health care provider."
d. "Resume taking the antidepressant for 2 more weeks, and then discontinue them again."
ANS: C
The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing.
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