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Chapter 60. Depression

Sebastian W is a 30-year-old man with chronic neuropathic pain and just lost his job due to consistently missing deadlines. He presents to his physician with troubling symptoms of decreased appetite and sleep, increased feelings of guilt and worthlessness, impaired concentration, and decreased interest in his usual hobbies. Sebastian's mother was diagnosed with major depressive disorder when she was 30. Sebastian's physician diagnoses him with major depressive disorder (MDD). Sebastian's doctor wants to start him on a medication with dual neurotransmitter effects to target his neuropathic pain and MDD. Which of the following antidepressants inhibit the reuptake of both norepinephrine (NE) and serotonin (5-HT)? Select all that apply.

a. Desipramine

b. Venlafaxine

c. Escitalopram

d. Phenelzine

e. Bupropion

Answer a is correct. Tricyclic antidepressants (TCAs) inhibit the reuptake of NE and 5-HT. All TCAs inhibit the reuptake of NE and 5-HT, but they may do so at different degrees. For example, amitriptyline inhibits the reuptake of 5-HT more than imipramine and imipramine inhibits the reuptake of NE more than amitriptyline. Therefore, TCAs have the same side-effect profile based upon mechanism of action, but they may cause a particular side effect at different percentages.

Answer b is correct. Serotonin norepinephrine reuptake inhibitors (SNRIs; venlafaxine, duloxetine, and levomilnacipran) inhibit the reuptake of NE and 5-HT. Venlafaxine inhibits 5-HT reuptake at low doses, with additional NE reuptake inhibition at higher doses. Duloxetine inhibits 5-HT and NE across all doses.

Answer c is incorrect. Selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin only.

Answer d is incorrect. Monoamine oxidase inhibitors (MAOIs) inhibit the reuptake of serotonin, norepinephrine, and dopamine.

Answer e is incorrect. Bupropion inhibit the reuptake of NE and dopamine.

Sebastian W is a 30-year-old man with chronic neuropathic pain and just lost his job due to consistently missing deadlines. He presents to his physician with troubling symptoms of decreased appetite and sleep, increased feelings of guilt and worthlessness, impaired concentration, and decreased interest in his usual hobbies. Sebastian's mother was diagnosed with major depressive disorder when she was 30. Sebastian's physician diagnoses him with major depressive disorder (MDD). Three months later, Sebastian returns to his doctor and mentions he is still having difficulty sleeping. Sebastian'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.

a. Serotonin (5-HT) receptor antagonist

b. 5-HT reuptake inhibitor

c. α1...

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