The Correct Answer is D!

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Question:

A 58 year-old female presents with a 6-week history of worsening sadness, decreased energy, inability to enjoy activities, hopelessness, and feelings of guilt. Her son recently announced a divorce which is distressing to her. She is moderately overweight and has diabetes and poorly controlled hypertension. You recommend supportive psychotherapy and pharmacotherapy.

Which of these medications is the best choice for the treatment of this patient’s medical condition?

  1. Amitriptyline
  2. Paroxetine
  3. Venlafaxine
  4. Citalopram
  5. Phenelzine

Rationale:

An antidepressant medication is recommended for the treatment of patients with mild to moderate depression and for those with severe depression unless the patient is to undergo electroconvulsive therapy. Decisions regarding therapy should be based on anticipated side effects, safety or tolerability of these side effect, drug metabolizing enzymes and drug-drug interactions, prior response to drug or drug class, cost and patient preference. Because of the relative comparability regarding the effectiveness of antidepressant mediation, choice of treatment should be tailored to the patient. Venlafaxine is known to cause or exacerbate hypertension and paroxetine is associated with weight gain. Thus, these medications would not be considered drugs of choice based on this patient’s health profile. Compared to other agents, citalopram has a favorable side effect profile with minimal interaction with the hepatic cytochrome P450 system and thus little drug-drug interactions.

1.  Source: "Comparative Analysis of Pre/Post Assessments of Live/Didactic Course Attendees when compared to Mico-Learning/Online Course Users., "Knowledge to Practice, 2017.