A 28-year-old woman IMG preparing for usmle step1 after failing with a score of 184(74)presents to the clinic for the first time with symptoms of major depressive disorder lasting several weeks. She requests medication because, apart from feeling low and tired, she feels distracted, forgetful, and unable to focus on her work. She reports having been diagnosed as a child with attention deficit/hyperactivity disorder and dyslexia, and she had been given methylphenidate. Which of the following therapeutic agents would be most appropriate for treatment?
A. Alprazolam
B. Bupropion
C. Lithium
D. Olanzapine
E. Paroxetine
B for generalized anxiety disorder, and it has less side effect than benzodiazepam group.
The correct answer is
B. Bupropion is an antidepressant with both dopaminergic and noradrenergic properties that would essentially help this patient not only improve depression but also cognitive functioning related to her prior history of attention deficit/hyperactivity disorder. Alprazolam (choice A) is a benzodiazepine with a rapid onset of action and a relatively short metabolite half-life. It has strong anxiolytic properties. Even though initially it was claimed to have antidepressant properties too, its highly addictive potential prevents it from wider and long-term use. Lithium (choice C) is a mood stabilizer with potential use for treatment of aggression in attention deficit/hyperactivity disorder. Lithium appears to be effective only as an adjunct in the treatment of depressive disorder. Its long-term use may cause cognitive impairment. Olanzapine (choice D) is an atypical antipsychotic with some mood stabilizing properties. It has not been used solely for treatment of depression. Paroxetine (choice E) is a selective serotonin reuptake inhibitor (SSRI). Although it is effective in most patients, its anticholinergic properties might impair cognitive function more in this case.