Question

A 65-year-old man with a history of hypertension, diabetes, and coronary heart disease is admitted for coronary artery bypass grafting. Post-operatively he is depressed and psychiatry is called. The QTC interval is prolonged greater than 500 ms, and the psychiatric consultant defers starting an antidepressant at the present time. Several weeks later at outpatient follow-up, the patient remains significantly depressed and a diagnosis of major depressive disorder (MDD) is made. Which of the following medications is least likely to prolong the patient's QTC further?

A. Citalopram
B. Escitalopram
C. Amitriptyline
D. Bupropion
E. Olanzapine

Answer 1

Among the antidepressants listed, Bupropion is the least likely to further prolong the QTC interval in a patient with existing QTC prolongation, making it a safer option compared to Citalopram, Escitalopram, Amitriptyline, and Olanzapine.

Step-by-step explanation:

A 65-year-old man with a history of hypertension, diabetes, and coronary heart disease is admitted for coronary artery bypass grafting and is found to be depressed post-operatively. Psychiatry evaluation reveals a prolonged QTC interval (greater than 500 ms), delaying the initiation of antidepressant therapy due to potential risks of further QTC prolongation. At a follow-up appointment, the patient remains significantly depressed, and a diagnosis of major depressive disorder (MDD) is confirmed. When selecting an antidepressant less likely to prolong the QTC interval, Bupropion is the medication of choice.

Bupropion is known to have a negligible effect on the QTC interval when compared to other antidepressants, making it safer for patients with pre-existing QTC prolongation. In contrast, Citalopram and Escitalopram are selective serotonin reuptake inhibitors (SSRIs) known for their potential to prolong the QTC interval. Amitriptyline, a tricyclic antidepressant, and Olanzapine, an antipsychotic, also have a higher risk of causing QTC prolongation. Therefore, among the options provided, Bupropion presents the least risk of further QTC interval prolongation.