Review Question - QID 103783

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Selective Serotonin Reuptake Inhibitors (SSRIs) QID: 103783 (M3.PY.12.48)

QID 103783 (Type "103783" in App Search)

A 28-year-old woman with no significant past medical history presents to your office with complaints of "feeling sad all the time." Despite a previous psychiatrist prescribing paroxetine, she continues to experience depressive symptoms. When you probe into her feelings about the medication, she states that she stopped taking the medication because she did not like the associated weight gain. What is the best pharmacologic alternative for this patient?

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Fluoxetine

0/1

Sertraline

0/1

Mirtazapine

100%

1/1

Citalopram

0/1

Buspirone

0/1

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The patient described requires an antidepressant with the least predisposition for weight gain, which, of the given choices, is fluoxetine (Prozac).

SSRIs are the first-line agents for the treatment of depression. These agents are associated with good efficacy and are much safer than other antidepressant classes, including MAO inhibitors and tricyclics. Side effects other than weight gain include sexual dysfunction, GI disturbance, and insomnia.

Epling writes that fluoxetine is associated not only with a low risk of weight gain, but also with weight loss. The average weight loss in obese patients is 3.3 kg (7 lb, 4 oz). No other SSRIs have similar evidence of weight loss.

Serretti et al. describe weight alteration properties of antidepressants in which amitriptyline, mirtazapine, and paroxetine were associated with a high risk of weight gain, whereas fluoxetine and bupropion were associated with weight loss.

Illustration A shows the mechanism of SSRIs. Serotonin reuptake is inhibited, leaving more serotonin in the synaptic cleft.

Incorrect Answers:
Answer 2: Sertraline is associated with weight gain.
Answer 3: Mirtazapine is associated with weight gain.
Answer 4: Citalopram is associated with weight gain.
Answer 5: Buspirone is not used to treat depression, only generalized anxiety disorder.

ILLUSTRATIONS: