A nurse is educating a group of nursing students about psychotherapeutic interventions for bipolar disorder. Select all the psychotherapeutic interventions that are commonly used for managing bipolar disorder.

Choice A rationale:

The nurse should teach the patient to avoid foods rich in tyramine while on an MAOI antidepressant. MAOIs inhibit the enzyme monoamine oxidase, which breaks down tyramine in the body. Accumulation of tyramine can lead to hypertensive crisis due to excessive release of norepinephrine. Tyramine-rich foods include aged cheeses, cured meats, fermented foods, and certain beverages like wine and beer.

Choice B rationale:

The nurse should also teach the patient to avoid herbal supplements while on an MAOI antidepressant. Herbal supplements can interact with MAOIs and lead to potentially dangerous effects, including serotonin syndrome. Herbal supplements like St. John's wort, ginseng, and others may increase serotonin levels when combined with MAOIs.

Choice D rationale:

The nurse should instruct the patient to avoid over-the-counter pain relievers, particularly those containing pseudoephedrine or phenylephrine, while taking an MAOI antidepressant. These substances can also interact with MAOIs and result in hypertensive crisis due to increased release of norepinephrine.

Choice C rationale:

Choice C (Foods high in vitamin C) is not a concern when taking an MAOI antidepressant. Vitamin C-rich foods do not interact with MAOIs or pose a risk of hypertensive crisis. Thus, this choice is incorrect in the context of MAOI use.

Choice E rationale:

Choice E (Foods high in calcium) is also not a concern when taking an MAOI antidepressant. Calcium-rich foods do not have interactions with MAOIs that would result in hypertensive crisis. This choice is not relevant to MAOI medication.

Choice C rationale:

The nurse should emphasize the importance of reporting any side effects to the healthcare provider when educating a patient with MDD who has been prescribed an atypical antidepressant. Side effects can vary from person to person, and prompt reporting allows the healthcare provider to monitor and manage any adverse reactions effectively.

Choice A Rationale:

Choice A (Taking the medication only as needed) is incorrect because atypical antidepressants, like other antidepressants, need to be taken consistently as prescribed. Taking them as needed may not provide the sustained therapeutic levels required to manage MDD effectively.

Choice B Rationale:

Choice B (Taking the medication on an empty stomach) is not a key aspect of medication adherence for atypical antidepressants. While some medications do require administration on an empty stomach, this is not a general guideline for all antidepressants.

Choice D Rationale:

Choice D (Stopping the medication abruptly if side effects occur) is incorrect. Abruptly stopping an antidepressant, including atypical ones, can lead to withdrawal symptoms and a sudden return of depressive symptoms. Discontinuation should be done under the guidance of a healthcare professional and usually involves tapering the dose.

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