Guptashutosh
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3. A 30-year-old woman has had progressive fatigue and muscle stiffness over the past 6 months. She is the primary caretaker for her three children and her elderly disabled parents and has had difficulty sleeping because of the needs of her children. She says that she has to stay motivated because of her responsibilities and has had no difficulty concentrating. She has not had suicidal ideation. She has had an increased appetite and has had a 14-kg (30-lb) weight gain over the past year. She has a previous history of binge-eating and purging by vomiting. She has no history of psychoactive substance abuse or dependence, cold or heat intolerance, or changes in bowel or urinary function. Range of motion of the upper extremities is limited by pain. There is no evidence of muscle atrophy. She has good eye contact. She describes her mood as down and stressed. Her affect is dysphoric and intermittently tearful. Which of the following is the most appropriate pharmacotherapy?
A ) Bupropion
B ) Diazepam
C ) Fluoxetine
D ) Imipramine
E ) Phenelzine
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| sarika
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Fluoxetine?
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| drashishmahajan
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WHAT IS THE DIAGNOSIS???? BULIMIA OR ATYPICAL DEPRESSION
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| CocaCola
Forum Guru
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depressed mood, increased appetite and weight gain, and fatigue... due to stress...
atypical depression -
Fluoxetine
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| anjushree
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atypical depression------maoi-----phenelzine
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| Chrales
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E is correct. anjushree you are right.
I answered this one wrong in my NBME test. Doh!!!!!! (although I even marked it in my "things to remember" list). I didn't notice the weight gain. this is the clue
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| jehanzebali
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atypical depression ???? why would the answer be phenelzine ???
aint ssri drug of choice for depression
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| 92306
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For atypical depression DOC is monoamine oxidase inhibitors like phenelzine .
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| dr in trouble
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atypical depression---what r the s/s of atypical depression???
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| Geroo
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guys what is the refrence that says MAOI is the first line treatment for atypical depression?
kaplan says that MAOI is a second line for atypical depression
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| robin082006
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For depression I always pick SSRI
In atypical depression, although it reponses well to MAOI but it also response well to SSRI, therefore, SSRI is prefered than MAOI because of less side effects.
This is Kaplan's and you can see this info by Google search.
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| r_albayunen
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you are right robin .. if you see depression without any history of sexual distubrances .. pick SSRI .. less SE.
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| jehanzebali
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CMDT AND HARRISON both mention SSRI being the DRUG OF CHOICE even for atypical depression.
both books mention the fact that MAOIs are THE MOST EFFECTIVE treatment for atypical depression, but their side effect profile make them SECOND LINE AGENTS.
(Only source i have that mentions MAOIs as the treatment for choice for atypical depression are kaplan highyield lectures which are now old and stand no where against these two text books)
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| arlete
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Worth remembering Bupropion is contra-indicated in patients with bulimia, because it increases the incidence of seizures.
I agree with SSRIs.
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| ram3
Forum Guru
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For depression i pick Fluoxetine
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| hanwin
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Atypical depression , MAOI
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| sailing boat
Forum Elite
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and also arlete bupropion is the only drug which does not cause sexual side effects,
and as u said dont give it with h/o seizures or also, h/o bulimia
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| wywywy2006
Forum Elite
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hi guys
One of her chief complaints is muscle pain. Does TCAs work better to relieve her muscle pain and also relieve her depression ?
SSRI can worsen her insomnia, doesn't it ?
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| gr8doc
Forum Senior
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A.
I know I'm the first one to pick Bupropion as the answer.
The points in favor :
1. The most important reason is that all the other anti depressants will cause her to gain more weight (mind you she has already gained 30Lb) except Bupropion which causes anorexia and hence weight loss.
I read in the one of the reviews earlier that Bupropion is contra indicated in Bulimia, Yes, I agree with that., but only that it is contraindicated as a treatment of Bulimia.
The rest of explanation is same as for any other anti depressants.
I will appreciate everyones views on this.
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| abc888
Forum Newbie
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D Imipramine
I agree with wywywy2006
TCA can treat both depression and pain (the main compaints!!)
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