F-Chapter 10: Antidepressants Flashcards
(10 cards)
A 55-year-old teacher began to experience changes in
mood. He was losing interest in his work and lacked
the desire to play his daily tennis match. He was
preoccupied with feelings of guilt, worthlessness, and
hopelessness. In addition to the psychiatric symptoms,
the patient complained of muscle aches throughout his
body. Physical and laboratory tests were unremarkable.
After 6 weeks of therapy with fluoxetine, his symptoms
resolved. However, the patient complains of sexual
dysfunction. Which of the following drugs might be
useful in this patient?
A. Fluvoxamine.
B. Sertraline.
C. Citalopram.
D. Mirtazapine.
E. Lithium.
D. Mirtazapine is largely free from sexual side effects. However, sexual dysfunction commonly occurs with SSRIs (fluvoxamine, sertraline, and citalopram), as well as with TCAs, and SNRIs. Lithium is used for the treatment of mania and bipolar disorder.
A 25-year-old woman has a long history of depressive
symptoms accompanied by body aches and pain
secondary to a car accident 2 years earlier. Physical
and laboratory tests are unremarkable. Which of the
following drugs might be useful in this patient?
A. Fluoxetine.
B. Sertraline.
C. Phenelzine.
D. Mirtazapine.
E. Duloxetine.
E. Duloxetine is a SNRI that can be used or depression accompanied by symptoms of pain. SSRIs (fluoxetine and sertraline), MAOIs (phenelzine), and atypical antidepressants (mirtazapine) have little activity against pain syndromes.
A 51-year-old woman with symptoms of major
depression also has angle-closure glaucoma. Which of
the following antidepressants should be avoided in this
patient?
A. Amitriptyline.
B. Sertraline.
C. Bupropion.
D. Mirtazapine.
E. Fluvoxamine.
A. Because of its potent antimuscarinic activity, amitriptyline should not be given to patients with glaucoma because of the risk of acute increases in intraocular pressure. The other antidepressants all lack antagonist activity at the muscarinic receptor.
A 36-year-old man presents with symptoms of
compulsive behavior. If anything is out of order, he
feels that “work will not be accomplished effectively or
efficiently.” He realizes that his behavior is interfering
with his ability to accomplish his daily tasks but cannot
seem to stop himself. Which of the following drugs
would be most helpful to this patient?
A. Imipramine.
B. Fluvoxamine.
C. Amitriptyline.
D. Tranylcypromine.
E. Lithium.
B. SSRIs are particularly effective in treating obsessive–compulsive disorder, and fluvoxamine is approved for this condition. The other drugs are less effective in the treatment of obsessive–compulsive disorder.
Which antidepressant has, as its two proposed
principle mechanisms of action, 5-HT1a
receptor
partial agonism and 5-HT reuptake inhibition?
A. Fluoxetine.
B. Aripiprazole.
C. Maprotiline.
D. Vilazodone.
E. Mirtazapine.
D. In addition to inhibition of serotonin reuptake, the antidepressant activity of vilazodone may be related to its 5-HT1areceptor agonism. Though aripiprazole is also proposed to have 5-HT1apartial agonism, it is not a serotonin reuptake inhibitor.
Which antidepressant is the most sedating?
A. Fluoxetine.
B. Duloxetine.
C. Nortriptyline.
D. Citalopram.
E. Venlafaxine.
C. Nortriptyline is the most sedating of the list due to its histamine-blocking activity. (See Figure 10.10.)
Which mood stabilizer is completely renally eliminated
and may be beneficial for patients with hepatic
impairment?
A. Valproic acid.
B. Carbamazepine.
C. Lithium.
D. Risperidone.
E. Aripiprazole
C. Lithium is the only agent for bipolar disorder that does not require hepatic metabolism and, thus, may be dosed without issue in a hepatically impaired patient. However, if the patient had renal impairment, the lithium dosage would have to be adjusted
Which antidepressant has, as its two principle
mechanisms of action, 5-HT2A
receptor antagonism
and α2
receptor antagonism?
A. Fluoxetine.
B. Doxepin.
C. Maprotiline.
D. Mirtazapine.
E. Selegiline.
D. Mirtazapine is the only antidepressant with this combination of mechanisms of action that are believed to contribute to its therapeutic effects. The other agents listed are reuptake inhibitors of either serotonin (fluoxetine) or norepinephrine (maprotiline), or both (doxepin), or act as a MAOI (selegiline).
Which agent is best known to have the side effect of
decreasing the thyroid function of the patient being
chronically treated with this agent?
A. Carbamazepine.
B. Lithium.
C. Valproic acid.
D. Chlorpromazine.
E. Lurasidone.
B. Lithium is best known for causing a drug-induced hypothyroidism in patients after long-term use. Though it is possible with other mood stabilizers, lithium has the most reported cases, and thus, thyroid function tests should be performed at baseline and during followup to monitor for this possible effect. Also, since hypothyroidism may present with symptoms of depression, it is important to differentiate a patient’sobserved depressive symptoms from the psychopathology of the bipolar disorder or depression versus symptoms of hypothyroidism.
Which agent would be a poor choice in a 70-year
old elderly female with depressive symptoms due to
the drug having significant α1
receptor antagonism
and thus a higher risk for falls due to orthostatic
hypotension?
A. Lithium.
B. Bupropion.
C. Escitalopram.
D. Imipramine.
E. Sertraline.
D. Lithium should not be used for depression in an elderly patient without first trying first-line antidepressants, and even then, it is used as an adjunct. Bupropion, sertraline, and escitalopram have very little effect on blood pressure (no α1receptor antagonism) and are considered acceptable choices for the treatment of depression in the elderly. Imipramine is associated with a high risk for orthostasis in the elderly and should be avoided due to its adverse effect profile and risk for falls.
