Question

A 20-year-old man comes to the psychiatry clinic reporting symptoms of irritable mood, inability to feel joy for his job as a river cruise boat captain, loss of energy, increased appetite with weight gain, and difficulty falling asleep at night. Symptoms have lasted for four and a half weeks and this is the second time in his life he has felt like this. Patient also has a history of epileptic seizures characterized by auras in which he experiences hallucinations and panic, followed by a minute or two of impaired consciousness. What would be the least indicated antidepressant for the treatment of his symptoms?

A. Buproprion
B. Mirtazapine
C. Fluoxetine
D. Paroxetine
E. Venlafaxine

Answer 1

B. Mirtazapine. Mirtazapine (option B) would be the least indicated antidepressant for the treatment of the described symptoms.

Step-by-step explanation:

The least indicated antidepressant for the treatment of the symptoms described would be Mirtazapine (option B).

Mirtazapine is an antidepressant that belongs to the class of medications known as noradrenergic and specific serotonergic antidepressants (NASSA). It works by increasing the release of norepinephrine and serotonin in the brain, which helps improve mood. However, one of the common side effects of mirtazapine is increased appetite and weight gain. Since the patient already reports increased appetite with weight gain as one of their symptoms, prescribing mirtazapine could exacerbate this issue.

Other antidepressants, such as bupropion (option A), fluoxetine (option C), paroxetine (option D), and venlafaxine (option E), may be more suitable for this patient as they are less likely to cause weight gain and increased appetite.