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Chapter 55: Depression

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Three months later Jimmy returns to his doctor and mentions he is still having difficulty sleeping. Jimmy’s doctor starts him on trazodone due to its sedating properties. Select the mechanism of action of trazodone that leads to the side effects of dizziness and sedation.

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a. 5-HT receptor antagonist

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b. 5-HT reuptake inhibitor

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c. Alpha1 adrenergic and histaminergic antagonism

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d. Angiotension receptor blockade

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Answer c is correct. α1-adrenergic receptor blockade and histaminergic antagonism may lead to dizziness and sedation. α1-adrenergic receptor blockade may lead to orthostatic hypotension, dizziness, and reflex tachycardia. Histaminergic antagonism may lead to sedation and weight gain.

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Answer a is incorrect. 5-HT receptor antagonism may lead to increased REM sleep, decreased sexual dysfunction (serotonin 2A receptor blockade), and increased appetite/weight gain (serotonin 2C receptor blockade).

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Answer b is incorrect. 5-HT reuptake inhibition may lead to anxiety, insomnia, sexual dysfunction, and anorexia.

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Answer d is incorrect. Trazodone does not block the angiotension receptor blocker.

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Select the antidepressant that has a black box warning for rare cases of liver failure.

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a. Mirtazapine

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b. Bupropion

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c. Amitriptyline

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d. Nefazodone

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Note: All antidepressants have the following black box warning: Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years of age) with major depressive disorder and other psychotic disorders.

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Answer d is correct. The use of nefazodone as an antidepressant has declined after reports of hepatotoxicity. The FDA-approved nefazodone labeling includes a black box warning describing rare cases of liver failure. Because of the potential for hepatic injury associated with nefazodone use, treatment should not be initiated in individuals with active liver disease or with elevated baseline serum transaminases.

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Answers a, b, and c are incorrect. None of these medications has a black box warning for hepatotoxicity.

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Which of the following antidepressants is classified as a dopamine reuptake inhibitor?

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a. Wellbutrin

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b. Elavil

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c. Prozac

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d. Cymbalta

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Answer a is correct. Bupropion (Wellbutrin) is an aminoketone that inhibits the reuptake of dopamine and norepinephrine.

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Answer b is incorrect. Amitriptyline (Elavil) is a TCA that inhibits the reuptake of norepinephrine and serotonin.

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