A 46-Year-Old Man Comes to the Office with a 2-Month

question 202

Multiple Choice

A 46-year-old man comes to the office with a 2-month history of depressed mood, low energy, and problems concentrating at work.  The patient has gained 4.5 kg (10 lb) and is disgusted with himself for not exercising.  He sleeps 14 hours a day and has difficulty getting out of bed.  He becomes tearful when describing how he loves his children but no longer feels happy to see them.  The patient denies any suicidal ideation, intent, or plan, but acknowledges that he contemplated suicide 4 years ago during his divorce proceedings.  At that time, he did not seek treatment but felt better over the course of the subsequent year.  The patient's physical examination and laboratory studies are within normal limits.  He is diagnosed with major depressive disorder and started on escitalopram.  After 6 weeks, there is no improvement and the patient is switched to sertraline, which is titrated up to the maximum dose.  On a follow-up visit 2 months later, he says that his depressive symptoms are only minimally improved.  The decision is made to discontinue sertraline and start a new medication.  Which of the following medications would be most appropriate for this patient?

• A)Amitriptyline
• B)Aripiprazole
• C)Bupropion
• D)Fluoxetine
• E)Lithium
• F)Mirtazapine
• G)Quetiapine

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Definitions:

Network Interface Card

A Network Interface Card (NIC) is a hardware component that connects a computer to a network, enabling it to communicate with other devices.

Router

A networking device that forwards data packets between computer networks.

Public Networks

Networking environments accessible by the general public, such as the internet, often less secure than private networks.

Hackers

Individuals skilled in technology who use their knowledge to gain unauthorized access to systems or networks, often for malicious purposes, but also can refer to ethical hackers who help improve security.