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A 72-year-old woman enters the hospital having lost 7 kg and saying she has no interest in eating. Her physical examination and laboratory findings are normal. She has been awakening at 5 a.m. for several months and cannot fall back to sleep. She says she has been feeling anxious and helpless since her husband died 3 years ago. Which one of the following is a reasonable medication to prescribe for her?

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1) olanzapine (Zyprexa®)

2) venlafaxine (Effexor®)

3) clonazepam (Rivotril®)

4) quetiapine (Seroquel®)

5) risperidone (Risperdol®)


2) venlafaxine




but 2 has insomnia side effect?


venlafaxine is serotonergic ,so should not cause insomnia.
other three are antiphychotic .cionazepam will produce excessive sedation.


2 is the only reasonable r not first line antidepressants


determine, are you sure?

'Venlafaxine has generally been reported to be well tolerated. The most common adverse reactions are nausea, somnolence, dry mouth...'
from 'Kaplan & Sadock's Concise Textbook of Clinical Psychiatry', 2nd ed. 2003, page 499.


Effexor is a good choice because it's the only antidepressant among meds mentioned, and she might be depressed. But I would go with Clonazepam coz she says she 's anxious, and Clonazepam would make her sleep and be less anxious.
What's the right answer, determine?




I thought as a SNRI, Venf. has also insomnia side effect. But I double checked, it has only %3 insomnia side eff.


I don`t have the right answer. I can`t decide between 2 AND 3?


I checked out- Effexor XR has been approved for both depression and Anxiety Disorder. I was choosing Clonazepam because of anxiety, Effexor has stimulating activity, so I thought prescribing it to smb with anxiety wouldn't be right. Apparently, I'm wrong-Effexor is the right choice-treats both depression and anxiety.


thanks rasul. i did'nt know the answer to this one.


thanks a lot friends smiling face


Effexor is an excellent choice for depression, pain control .



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