A 78-Year-Old Man Comes to the Office Due to Depressed

question 396

Multiple Choice

A 78-year-old man comes to the office due to depressed mood, decreased appetite, difficulty concentrating, and hypersomnia.  He has lost interest in his hobby of woodworking and no longer enjoys socializing with friends and family.  The patient has no previous psychiatric history.  His other medical problems include hypertension, dyslipidemia, type II diabetes, and peripheral neuropathy that has seemed "a lot more painful lately."  He takes lisinopril, atorvastatin, metformin, sitagliptin, and pregabalin.
Physical examination shows distal loss of sensation to pinprick, light touch, and vibration in the feet and lower legs bilaterally.  Laboratory studies are unremarkable.  Based on this presentation, the patient is diagnosed with major depressive disorder.
Which of the following antidepressant medications would be best for this patient?

• A)Amitriptyline
• B)Duloxetine
• C)Fluoxetine
• D)Mirtazapine
• E)Sertraline

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