Match each clinical vignette describing a patient with major depressive disorder to the most appropriate first-line antidepressant based on their specific comorbidities and symptom profile.
- A 34-year-old man with major depressive disorder requests treatment but is highly concerned about potential sexual dysfunction and expresses a strong desire to quit smoking.Bupropion
- A 78-year-old woman with major depressive disorder experiences severe difficulty initiating sleep, poor appetite, and an unintentional 5-kg (11-lb) weight loss over the past month.Mirtazapine
- A 45-year-old woman with major depressive disorder also suffers from chronic burning pain in her bilateral lower extremities due to diabetic peripheral neuropathy.Duloxetine
- A 22-year-old woman with major depressive disorder and comorbid bulimia nervosa requires treatment, but her chart notes frequent hospitalizations for hypokalemia.Fluoxetine
Answer
Vignette 1 matches Bupropion; Vignette 2 matches Mirtazapine; Vignette 3 matches Duloxetine; Vignette 4 matches Fluoxetine.
Optimal pharmacotherapy for major depressive disorder relies on utilizing the unique pharmacological properties of specific antidepressants. Bupropion is ideal for patients seeking smoking cessation who wish to avoid sexual dysfunction. Mirtazapine's sedating and appetite-stimulating effects benefit patients with insomnia and weight loss. SNRIs like duloxetine treat comorbid neuropathic pain. Fluoxetine is uniquely indicated for bulimia nervosa, a condition in which bupropion is strictly contraindicated.
Step-by-Step Solution
Key Concept
Antidepressant selection must be tailored to individual patients by matching the medication's specific mechanism of action and side-effect profile to the patient's unique symptoms and medical comorbidities.