A 12 year old girl is brought to your office by her mother. Her mother is concerned because the girl is refusing to go to school. She has few friends and has been the object of bullying in the past although that seems to be resolved now. She used to be involved in sports but has stopped. No medical issues are identified and a diagnosis of depression is made. In addition to counseling, what drug might be appropriate?
Amitriptyline
Buproprion
Mirtazepine
Fluoxetine
Trazodone
A 35 year old woman is complaining that her paroxetine is not helping her with her symptoms of depression. She has been on the drug for 6 weeks and you decide to change her to venlafaxine. A couple of days after starting venlafaxine she comes to your office complaining that it is making her worse – she find herself crying for no reason and excessively irritable. What do you say to her?
You agree that she is getting worse but suggest that it is because she is feeling stress over changing her medication.
You explain that paroxetine can cause a discontinuation syndrome and advise her that it will resolve in a few more days.
You explain that the venlafaxine will increase crying and irritability but will nevertheless improve her depression.
You agree that she is getting worse and change her diagnosis to anxiety and prescribe lorazepam instead of venlafaxine.
A 40 year old man has depression that has been well controlled for the past 6 months. He agrees that he socializes with friends and enjoys life more now than before he started his drug therapy. However, he complains that he sometimes feels “woozy” when he stands up, he has gained 10 lbs in weight, he has a dry mouth and his eyesight has deteriorated. What drug has he been taking?
A 55 year old woman who lives alone has been taking antidepressants for many years. Over the years, she has taken sertraline, venlafaxine and citalopram. She is now taking escitalopram but still finds that some days she “can’t get going” and calls in sick to work. What might be the next choice for her medication?
Try a new drug, such as amitriptyline.
Try a new drug, such as bupropion.
She is obviously treatment resistant, so try a monoamine oxidase inhibitor such as tranylcypromine.
Increase her dose of escitalopram.
Try an adjunctive medication.
