Soru

During a routine oncology follow-up, a 52-year-old female patient reports an eight-week history of persistently low mood, loss of interest in activities she previously enjoyed, early morning awakenings, and severe fatigue. She has a history of estrogen receptor-positive breast cancer that was treated with surgical resection and radiation therapy two years ago. She is currently maintained on daily tamoxifen to prevent cancer recurrence. Vital signs include a blood pressure of $124/78 \text{ mm Hg}$, pulse of $72/\text{min}$, and temperature of $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$). Mental status examination reveals a tearful, blunted affect and psychomotor retardation, with no evidence of psychosis or suicidal ideation. A diagnosis of major depressive disorder is established, and pharmacotherapy is considered. Which of the following antidepressants should be strictly avoided in this patient to prevent a reduction in the efficacy of her antineoplastic therapy?