NR 547 Week 5 Study Guide: Depressive & Bipolar Disorders
| (Latest 2025/2026) Psychiatric-Mental Health Nurse
Practitioner | Antidepressants, Mood Stabilizers, DSM-5
Criteria | Q&A | Grade A | 100% Correct Verified Answers
Subject: Psychiatric-Mental Health – SSRIs, SNRIs, NDRIs (Mechanism, Side Effects, Mnemonics,
Prescribing Pearls, Steps to Achieve Effective Dose); SSRI Side Effects (7 S's); SNRI Side Effects
(SHAT, BAD); MDD Specifiers (Melancholic, Atypical, Mixed Features, Anxious Distress, Psychotic,
Peripartum Onset, Seasonal Pattern); Dysthymia (Persistent Depressive Disorder); Bipolar Disorder
(Manic vs Hypomanic Episode Criteria, Rapid Cycling, Mixed Episodes, Medical Mimics, Substances
Mimicking Bipolar); Mood Stabilizers (Lithium, Lamotrigine, Valproic Acid, Carbamazepine, Second-
Generation Antipsychotics); Lamotrigine Rash (Stevens-Johnson Syndrome); Screening
Recommendations (USPSTF, AAFP, AAP, Medicaid EPSDT); Postpartum Depression (Sertraline,
EPDS); PMDD; Mental Status Exam; Clinical Cases.
Source: NR 547 Week 5 Study Guide, DSM-5-TR, APA Guidelines.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
SSRIs – mechanism of action
Correct Answer: Inhibit serotonin reuptake (reabsorption) so there is more serotonin available at the
synapse.
1. Increased serotonin enhances neurotransmission, improving mood, anxiety, and impulse control.
Onset of therapeutic effect 2-6 weeks.
SNRIs – mechanism of action
Correct Answer: Inhibit serotonin and norepinephrine reuptake while also increasing dopamine in
the prefrontal cortex (improve cognition).
1. Both SNRIs and NDRIs are useful for patients who struggle with energy, focus, alertness, motivation,
and/or cognition.
NDRIs – mechanism of action
Correct Answer: Inhibit norepinephrine and dopamine reuptake (increase energy, alertness,
motivation). Bupropion is the prototype.
1. Contraindicated in seizure disorders and eating disorders (lowers seizure threshold). Not first-line for
anxiety.
Steps to achieving an effective dose to promote symptom remission and positive outcomes
Correct Answer: 1) Start with lowest dose and increase gradually (2-4 weeks between each dose
increase). 2) If higher dose does not achieve efficacy, switch to different drug within same
medication class. 3) If still not working, switch to different drug class. 4) If still not working,
supplement with an additional medication (augmentation).
1. Example: sertraline → fluoxetine (same class) → venlafaxine (different class) → add bupropion
(augmentation).
, SSRI examples
Correct Answer: Fluoxetine, sertraline, citalopram (Celexa), escitalopram, paroxetine, fluvoxamine.
1. Duloxetine, mirtazapine, trazodone are not SSRIs (duloxetine is SNRI; mirtazapine is TeCA; trazodone
is SARI).
Serotonin side effects (mnemonic)
Correct Answer: Head (decreased anxiety, impulsivity, sex drive); Red (platelets and bleeding –
increased bleeding risk); Fed (GI motility and nausea).
1. SSRIs increase bleeding risk (especially with NSAIDs, anticoagulants). GI side effects (nausea,
diarrhea) often transient.
Fluoxetine (Prozac) – prescribing pearl
Correct Answer: Longest half-life (4-6 days). Good for patients who may forget to take pills on time.
Avoid abrupt discontinuation (prolonged withdrawal).
1. Mnemonic: "FLU" and that one long week you spent in bed – describes fluoxetine's long half-life.
Sertraline (Zoloft) – prescribing pearl
Correct Answer: "Squirtraline" – harsher GI effects; safe for breastfeeding women (lowest infant
exposure). Also treats social anxiety and hypersomnolence.
Citalopram (Celexa) – prescribing pearl and warning
Correct Answer: "Celexas" – A Lexus (car) – get an electrocardiogram (ECG) if on this drug. Causes
QT prolongation (dose-dependent). Max dose 40 mg/day (20 mg in elderly, hepatic impairment).
1. Has mild antihistamine effects.
Escitalopram (Lexapro) – prescribing pearl
Correct Answer: No known drug interactions. Preferred for patients on polypharmacy.
Paroxetine (Paxil) – prescribing pearl
Correct Answer: Also treats social anxiety and insomnia. Highest anticholinergic burden among
SSRIs; avoid in elderly (Beers criteria).
Duloxetine (Cymbalta) – prescribing pearl
Correct Answer: "DULLS the pain" – use in fibromyalgia, diabetic neuropathy, or premenstrual
symptoms. Effective for atypical pain at higher doses. Appropriate for clients who present with
somatic symptoms of depression.
Mirtazapine (Remeron) – prescribing pearl
Correct Answer: "MEAL-tazapine" – increase appetite (helps with weight gain). Also helps with sleep
(sedating). Useful for depression with insomnia and weight loss.
Trazodone – prescribing pearl
Correct Answer: "tra-ZZZ-odone" – can assist with sleep disturbances. Often used off-label for
insomnia (low doses 25-100 mg). Sedating, minimal anticholinergic effects.
SSRI side effects – 7 S's mnemonic
Correct Answer: Stomach upset, Sexual dysfunction, Serotonin syndrome, Sleep difficulties,
Suicidal thoughts (black box warning), Stress (anxiety initial activation), Size increase (weight gain).
1. Most adverse effects subside after 4-5 days once the body adjusts to increased serotonin levels.
However, sexual dysfunction may persist.
| (Latest 2025/2026) Psychiatric-Mental Health Nurse
Practitioner | Antidepressants, Mood Stabilizers, DSM-5
Criteria | Q&A | Grade A | 100% Correct Verified Answers
Subject: Psychiatric-Mental Health – SSRIs, SNRIs, NDRIs (Mechanism, Side Effects, Mnemonics,
Prescribing Pearls, Steps to Achieve Effective Dose); SSRI Side Effects (7 S's); SNRI Side Effects
(SHAT, BAD); MDD Specifiers (Melancholic, Atypical, Mixed Features, Anxious Distress, Psychotic,
Peripartum Onset, Seasonal Pattern); Dysthymia (Persistent Depressive Disorder); Bipolar Disorder
(Manic vs Hypomanic Episode Criteria, Rapid Cycling, Mixed Episodes, Medical Mimics, Substances
Mimicking Bipolar); Mood Stabilizers (Lithium, Lamotrigine, Valproic Acid, Carbamazepine, Second-
Generation Antipsychotics); Lamotrigine Rash (Stevens-Johnson Syndrome); Screening
Recommendations (USPSTF, AAFP, AAP, Medicaid EPSDT); Postpartum Depression (Sertraline,
EPDS); PMDD; Mental Status Exam; Clinical Cases.
Source: NR 547 Week 5 Study Guide, DSM-5-TR, APA Guidelines.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
SSRIs – mechanism of action
Correct Answer: Inhibit serotonin reuptake (reabsorption) so there is more serotonin available at the
synapse.
1. Increased serotonin enhances neurotransmission, improving mood, anxiety, and impulse control.
Onset of therapeutic effect 2-6 weeks.
SNRIs – mechanism of action
Correct Answer: Inhibit serotonin and norepinephrine reuptake while also increasing dopamine in
the prefrontal cortex (improve cognition).
1. Both SNRIs and NDRIs are useful for patients who struggle with energy, focus, alertness, motivation,
and/or cognition.
NDRIs – mechanism of action
Correct Answer: Inhibit norepinephrine and dopamine reuptake (increase energy, alertness,
motivation). Bupropion is the prototype.
1. Contraindicated in seizure disorders and eating disorders (lowers seizure threshold). Not first-line for
anxiety.
Steps to achieving an effective dose to promote symptom remission and positive outcomes
Correct Answer: 1) Start with lowest dose and increase gradually (2-4 weeks between each dose
increase). 2) If higher dose does not achieve efficacy, switch to different drug within same
medication class. 3) If still not working, switch to different drug class. 4) If still not working,
supplement with an additional medication (augmentation).
1. Example: sertraline → fluoxetine (same class) → venlafaxine (different class) → add bupropion
(augmentation).
, SSRI examples
Correct Answer: Fluoxetine, sertraline, citalopram (Celexa), escitalopram, paroxetine, fluvoxamine.
1. Duloxetine, mirtazapine, trazodone are not SSRIs (duloxetine is SNRI; mirtazapine is TeCA; trazodone
is SARI).
Serotonin side effects (mnemonic)
Correct Answer: Head (decreased anxiety, impulsivity, sex drive); Red (platelets and bleeding –
increased bleeding risk); Fed (GI motility and nausea).
1. SSRIs increase bleeding risk (especially with NSAIDs, anticoagulants). GI side effects (nausea,
diarrhea) often transient.
Fluoxetine (Prozac) – prescribing pearl
Correct Answer: Longest half-life (4-6 days). Good for patients who may forget to take pills on time.
Avoid abrupt discontinuation (prolonged withdrawal).
1. Mnemonic: "FLU" and that one long week you spent in bed – describes fluoxetine's long half-life.
Sertraline (Zoloft) – prescribing pearl
Correct Answer: "Squirtraline" – harsher GI effects; safe for breastfeeding women (lowest infant
exposure). Also treats social anxiety and hypersomnolence.
Citalopram (Celexa) – prescribing pearl and warning
Correct Answer: "Celexas" – A Lexus (car) – get an electrocardiogram (ECG) if on this drug. Causes
QT prolongation (dose-dependent). Max dose 40 mg/day (20 mg in elderly, hepatic impairment).
1. Has mild antihistamine effects.
Escitalopram (Lexapro) – prescribing pearl
Correct Answer: No known drug interactions. Preferred for patients on polypharmacy.
Paroxetine (Paxil) – prescribing pearl
Correct Answer: Also treats social anxiety and insomnia. Highest anticholinergic burden among
SSRIs; avoid in elderly (Beers criteria).
Duloxetine (Cymbalta) – prescribing pearl
Correct Answer: "DULLS the pain" – use in fibromyalgia, diabetic neuropathy, or premenstrual
symptoms. Effective for atypical pain at higher doses. Appropriate for clients who present with
somatic symptoms of depression.
Mirtazapine (Remeron) – prescribing pearl
Correct Answer: "MEAL-tazapine" – increase appetite (helps with weight gain). Also helps with sleep
(sedating). Useful for depression with insomnia and weight loss.
Trazodone – prescribing pearl
Correct Answer: "tra-ZZZ-odone" – can assist with sleep disturbances. Often used off-label for
insomnia (low doses 25-100 mg). Sedating, minimal anticholinergic effects.
SSRI side effects – 7 S's mnemonic
Correct Answer: Stomach upset, Sexual dysfunction, Serotonin syndrome, Sleep difficulties,
Suicidal thoughts (black box warning), Stress (anxiety initial activation), Size increase (weight gain).
1. Most adverse effects subside after 4-5 days once the body adjusts to increased serotonin levels.
However, sexual dysfunction may persist.
