MKSAP Quiz: depression medication
MKSAP Quiz: depression medication
A 37-year-old man is evaluated during a routine visit and reports feeling depressed. He meets the criteria for major depression and generalized anxiety disorder. The medical history is otherwise noncontributory.
The physical examination, including vital signs, is normal. Laboratory studies are unremarkable.
Which of the following is the most appropriate treatment option for this patient?
A. Paroxetine
B. Bupropion
C. Clonazepam
D. Risperidone
MKSAP Answer and Critique
The correct answer is A) Paroxetine. This item is available online to MKSAP 14 subscribers in the General Internal Medicine section, Item 120.
This patient has major depression and generalized anxiety disorder and should receive paroxetine. All the selective serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitors are effective for depression and generalized anxiety disorder and have Food and Drug Administration (FDA) approval for these indications. Bupropion is a proven antidepressant and clonazepam is a proven anxiolytic, but neither is FDA-approved for treating depression and anxiety. The atypical antipsychotic agents, such as risperidone, olanzapine, and quetiapine, are sometimes added to antidepressant therapy to augment response in patients with treatment-resistant major depressive disorder but are not indicated as monotherapy for major depression and dysthymia or generalized anxiety disorder.
Patients with depression commonly have some symptoms of anxiety also, and approximately one-third meet the criteria for a concomitant anxiety disorder. Depressive symptoms often respond more quickly to treatment than do anxiety symptoms, and it is not uncommon for anxiety to be "unmasked" during the first few weeks of antidepressant treatment.
Key Point
- All the selective serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitors are effective for depression and generalized anxiety disorder and have Food and Drug Administration approval for these indications. Depressive symptoms often respond more quickly to treatment than do anxiety symptoms, and it is not uncommon for anxiety to be "unmasked" during the first few weeks of antidepressant treatment.