Question 1
A 32-year-old female with a history of major depressive disorder (MDD) is being initiated on antidepressant therapy after discussing treatment options with her psychiatrist. The patient expresses a desire to avoid sexual side effects commonly associated with selective serotonin reuptake inhibitors (SSRIs). Which of the following medications would be the most appropriate initial choice?
A) Sertraline
B) Fluoxetine
C) Bupropion
D) Paroxetine
E) Escitalopram
Rationale: This drug is an antidepressant that works differently from selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) by affecting dopamine and norepinephrine levels. It is commonly chosen for patients who are concerned about the sexual side effects often associated with SSRIs and SNRIs. Bupropion is beneficial not only for treating depression but also for aiding in smoking cessation. It is less likely to cause sexual dysfunction, making it an appropriate choice for this patient.
Question 2
A patient newly diagnosed with depression is started on fluoxetine. After four weeks of treatment, the patient reports feeling “a bit better” but is experiencing insomnia and has heard that another medication might not cause this issue. Which of the following antidepressants is less likely to cause insomnia and might be considered as an alternative?
A) Sertraline
B) Venlafaxine
C) Mirtazapine
D) Bupropion
E) Citalopram
Rationale: This drug is an antidepressant that is known for its sedative properties, making it a suitable option for patients who experience insomnia with other antidepressants. Unlike SSRIs and bupropion, which can exacerbate insomnia due to their activating effects, mirtazapine often helps patients sleep better due to its mechanism of action, which includes antagonism of central presynaptic α2-adrenergic inhibitory autoreceptors and heteroreceptors, increasing the release of norepinephrine and serotonin. Additionally, its antihistaminic effects contribute to its sedative qualities. Therefore, it could be a better alternative for this patient.
Question 3
A patient has been taking escitalopram for several weeks for generalized anxiety disorder but reports significant nausea and sexual dysfunction. The patient’s psychiatrist decides to switch medications. Which of the following options is less likely to cause these side effects?
A) Fluoxetine
B) Duloxetine
C) Venlafaxine
D) Vilazodone
E) Paroxetine
Rationale: This drug is an antidepressant that acts as a selective serotonin reuptake inhibitor and a partial agonist at the 5-HT1A receptors. It is associated with a lower risk of sexual dysfunction compared to other SSRIs, possibly due to its unique mechanism of action. Additionally, vilazodone has a more favorable side effect profile regarding gastrointestinal side effects like nausea when compared to other SSRIs and SNRIs. Thus, it might be a suitable alternative for a patient experiencing nausea and sexual dysfunction on escitalopram.
Question 4
A 45-year-old male with a history of depression and alcohol use disorder is in need of antidepressant therapy. Which of the following antidepressants should be avoided due to a higher risk of interaction with alcohol?
A) Sertraline
B) Fluoxetine
C) Bupropion
D) Citalopram
E) Escitalopram
Rationale: This drug should be used with caution in patients with a history of alcohol use disorder due to the increased risk of seizures when combined with alcohol, especially in situations of sudden alcohol cessation. Bupropion lowers the seizure threshold, and its risk is dose-dependent. Patients with alcohol use disorder are already at a higher risk for seizures, making the combination potentially dangerous. The other options, SSRIs, generally do not have this increased risk when combined with alcohol, making them safer alternatives in this context.
Question 5
A 56-year-old female patient presents with complaints of depression that is worse in the winter months. She has a past medical history significant for osteoporosis and glaucoma. Which of the following antidepressants is most appropriate for her seasonal affective disorder (SAD)?
A) Fluoxetine
B) Bupropion XL
C) Amitriptyline
D) Venlafaxine
E) Mirtazapine
Rationale: This drug is indicated for the treatment of seasonal affective disorder (SAD) and is a suitable option for patients like the one described. It has the advantage of being well tolerated, with a lower risk of sexual side effects and weight gain compared to other antidepressants. Amitriptyline, a tricyclic antidepressant, is not recommended due to its anticholinergic side effects, which could exacerbate glaucoma. Bupropion does not have these risks and thus is more appropriate for a patient with her medical history.
Question 6
A patient with major depressive disorder is started on an antidepressant regimen. After two weeks, the patient reports an increase in restlessness and anxiety. Which of the following medications is most likely responsible for these side effects?
A) Mirtazapine
B) Sertraline
C) Amitriptyline
D) Bupropion
E) Trazodone
Rationale: This drug, an SSRI, is known to cause increased anxiety and restlessness, especially during the initial weeks of treatment. This is due to its mechanism of selectively inhibiting serotonin reuptake, which can initially lead to an imbalance in serotonin levels and result in increased anxiety symptoms. These side effects often diminish over time as the patient’s body adjusts to the medication. Other options like mirtazapine and trazodone are less likely to cause these effects due to their sedative properties.
Question 7
A 60-year-old male with a history of major depressive disorder and benign prostatic hyperplasia (BPH) is being considered for a new antidepressant. Which of the following medications should be avoided due to potential exacerbation of his BPH symptoms?
A) Venlafaxine
B) Duloxetine
C) Trazodone
D) Escitalopram
E) Bupropion
Rationale: This drug is an antidepressant that can lead to anticholinergic side effects, such as urinary retention, which can exacerbate symptoms of benign prostatic hyperplasia (BPH). Its mechanism of action includes blocking alpha-1 adrenergic receptors, which can worsen urinary symptoms in patients with BPH. The other listed antidepressants do not have significant anticholinergic effects or alpha-1 blocking activity, making them safer alternatives for a patient with BPH.
Question 8
A 24-year-old woman with depression and a seizure disorder is being evaluated for antidepressant therapy. Which of the following medications should be avoided due to the increased risk of seizures?
A) Fluoxetine
B) Escitalopram
C) Bupropion
D) Sertraline
E) Citalopram
Rationale: This drug has a higher risk of inducing seizures compared to other antidepressants, particularly at higher doses. This risk is especially pertinent in patients with a history of a seizure disorder. Its mechanism involves the inhibition of dopamine and norepinephrine reuptake, which can lower the seizure threshold. Given this patient’s seizure disorder, an SSRI like fluoxetine, escitalopram, sertraline, or citalopram would be a safer choice due to their lower seizure risk.
Question 9
A 35-year-old patient with major depressive disorder is being treated with paroxetine. The patient plans to become pregnant and inquires about the safety of continuing this medication during pregnancy. Which of the following is the most appropriate response regarding the use of paroxetine in pregnancy?
A) It is safe to use throughout pregnancy without any concerns.
B) It may be associated with cardiac defects in the first trimester.
C) It significantly increases the risk of neural tube defects.
D) It is associated with a high risk of gestational diabetes.
E) It is only contraindicated in the third trimester.
Rationale: This drug, an SSRI, has been associated with an increased risk of cardiac defects in newborns when used during the first trimester of pregnancy. This risk, although low, is significant enough to warrant caution or consideration of alternative antidepressants during pregnancy, especially in the first trimester. The FDA has issued warnings regarding the use of paroxetine by pregnant women due to these potential risks. It’s important for healthcare providers to weigh the benefits and risks of continuing paroxetine in women who are pregnant or planning to become pregnant.
Question 10
A patient with depression and chronic kidney disease (CKD) stage 3 is being evaluated for antidepressant therapy. Which of the following antidepressants is considered safe and does not require dose adjustment in patients with CKD?
A) Sertraline
B) Duloxetine
C) Amitriptyline
D) Citalopram
E) Venlafaxine
Rationale: This drug is considered safe for use in patients with chronic kidney disease and generally does not require dose adjustments because it is primarily metabolized by the liver. Unlike some other antidepressants, such as duloxetine, which is contraindicated in severe renal impairment due to its renal excretion and potential for accumulation, sertraline offers a safer profile for patients with CKD. Amitriptyline and venlafaxine may require careful monitoring or dose adjustments due to their pharmacokinetics in renal impairment. Thus, sertraline is a preferred option for patients with depression and CKD.