Mood stabilizers mechanisms and selection US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Mood stabilizers mechanisms and selection. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Mood stabilizers mechanisms and selection US Medical PG Question 1: A 58-year-old man with a past medical history of diabetes, hypertension, and hyperlipidemia was brought into the emergency department by his wife after she observed him go without sleep for several days and recently open and max out several credit cards. She also reports that he has quit his bartending job and has been excessively talkative and easily annoyed for the last several weeks. The patient has no previous psychiatric history. Routine medical examination, investigations, and toxicology rule out a medical cause or substance abuse. Lab results are consistent with chronically impaired renal function. What is the single best treatment for this patient?
- A. Valproic acid (Correct Answer)
- B. Lithium
- C. Gabapentin
- D. Pregabalin
- E. Lamotrigine
Mood stabilizers mechanisms and selection Explanation: ***Valproic acid***
- This patient presents with symptoms highly suggestive of **acute mania (Bipolar I disorder)**, including decreased need for sleep, impulsivity (maxing out credit cards), grandiosity (quitting job), pressured speech (excessively talkative), and irritability. **Valproic acid** is a first-line treatment for **acute mania**, particularly when kidney function is impaired.
- Given the patient's **chronically impaired renal function**, valproic acid is preferred over lithium as its excretion is primarily hepatic, minimizing the risk of drug accumulation and toxicity in the context of renal impairment.
*Lithium*
- While **lithium** is a highly effective mood stabilizer for bipolar disorder, it is predominantly cleared renally.
- The patient's **impaired renal function** would significantly increase the risk of **lithium toxicity**, making it a less safe and unsuitable choice in this scenario.
*Gabapentin*
- **Gabapentin** is an anticonvulsant primarily used for neuropathic pain and seizure disorders, sometimes used off-label as an adjunct for anxiety or sleep.
- It is **not a primary mood stabilizer** and lacks sufficient evidence for monotherapy treatment of acute mania in bipolar disorder.
*Pregabalin*
- **Pregabalin**, similar to gabapentin, is an anticonvulsant and neuropathic pain medication.
- It is **not indicated as a first-line treatment** for acute mania due to insufficient efficacy as a mood stabilizer.
*Lamotrigine*
- **Lamotrigine** is an effective mood stabilizer, particularly for the **depressive phases of bipolar disorder**, and for maintenance therapy.
- However, it has limited efficacy in treating **acute manic episodes**, making it less suitable for the patient's current presentation.
Mood stabilizers mechanisms and selection US Medical PG Question 2: A 45-year-old obese man is evaluated in a locked psychiatric facility. He was admitted to the unit after he was caught running through traffic naked while tearing out his hair. His urine toxicology screening was negative for illicit substances and after careful evaluation and additional history, provided by his parents, he was diagnosed with schizophrenia and was treated with aripiprazole. His symptoms did not improve after several dosage adjustments and he was placed on haloperidol, but this left him too lethargic and slow and he was placed on loxapine. After several dosage adjustments today, he is still quite confused. He describes giant spiders and robots that torture him in his room. He describes an incessant voice screaming at him to run away. He also strongly dislikes his current medication and would like to try something else. Which of the following is indicated in this patient?
- A. Haloperidol
- B. Olanzapine
- C. Chlorpromazine
- D. Fluphenazine
- E. Clozapine (Correct Answer)
Mood stabilizers mechanisms and selection Explanation: ***Clozapine***
- This patient has **treatment-resistant schizophrenia**, indicated by a lack of response to multiple trials of antipsychotics, including aripiprazole (atypical), haloperidol (typical), and loxapine (atypical).
- **Clozapine** is the only antipsychotic proven effective for treatment-resistant schizophrenia, significantly reducing psychotic symptoms and suicidality.
*Haloperidol*
- Haloperidol is a **first-generation antipsychotic** that the patient has already tried and found to be too sedating and slow.
- Continuing with haloperidol would likely result in persistent side effects and inadequate symptom control given his prior negative experience.
*Olanzapine*
- Olanzapine is a **second-generation atypical antipsychotic**; however, it is not typically indicated as a first-line treatment for treatment-resistant schizophrenia after failure of multiple agents.
- While effective for schizophrenia, it would be less effective than clozapine in a patient who has failed several previous antipsychotic trials.
*Chlorpromazine*
- Chlorpromazine is a **first-generation antipsychotic** that carries a higher risk of sedation, extrapyramidal symptoms, and anticholinergic side effects.
- It is unlikely to be more effective than haloperidol, which the patient already found too sedating and slow, and would not be the preferred choice for treatment-resistant schizophrenia.
*Fluphenazine*
- Fluphenazine is a **first-generation antipsychotic** with potent dopamine D2 receptor blockade, often leading to significant extrapyramidal side effects.
- Like other first-generation antipsychotics, it is not indicated as the next step for treatment-resistant schizophrenia after failure of multiple trials.
Mood stabilizers mechanisms and selection US Medical PG Question 3: A 56-year-old man comes to the physician for a follow-up examination. One month ago, he was diagnosed with a focal seizure and treatment with a drug that blocks voltage-gated sodium channels was begun. Today, he reports that he has not had any abnormal body movements, but he has noticed occasional double vision. His serum sodium is 132 mEq/L, alanine aminotransferase is 49 U/L, and aspartate aminotransferase is 46 U/L. This patient has most likely been taking which of the following drugs?
- A. Carbamazepine (Correct Answer)
- B. Topiramate
- C. Lamotrigine
- D. Gabapentin
- E. Levetiracetam
Mood stabilizers mechanisms and selection Explanation: ***Carbamazepine***
- This patient's symptoms of **double vision (diplopia)**, **hyponatremia** (serum sodium 132 mEq/L), and mild elevation in **liver enzymes** (ALT 49 U/L, AST 46 U/L) are classic side effects of carbamazepine.
- Carbamazepine blocks **voltage-gated sodium channels**, which is consistent with the initial treatment description for focal seizures.
- Hyponatremia occurs due to **SIADH (syndrome of inappropriate antidiuretic hormone secretion)**, a well-known adverse effect.
*Topiramate*
- Common side effects include **cognitive slowing**, **paresthesias**, and **kidney stones**, which are not reported by the patient.
- While it can cause weight loss and metabolic acidosis, **diplopia** and **hyponatremia** are not typical adverse effects.
*Lamotrigine*
- Also blocks voltage-gated sodium channels but has a different side effect profile.
- The most significant and potentially life-threatening side effect is a severe skin rash known as **Stevens-Johnson syndrome (SJS)** or toxic epidermal necrolysis (TEN).
- It does not commonly cause **diplopia** or significant **hyponatremia**.
*Gabapentin*
- Primarily acts by binding to the **α2δ subunit of voltage-gated calcium channels** and is NOT a sodium channel blocker.
- Side effects typically include **dizziness**, **somnolence**, and peripheral edema, not the constellation of symptoms presented.
*Levetiracetam*
- Its mechanism of action involves binding to the **synaptic vesicle protein 2A (SV2A)**, a unique target, and it is NOT a voltage-gated sodium channel blocker.
- Common side effects include behavioral changes (**irritability**, **aggression**) and **somnolence**, but not diplopia or hyponatremia.
Mood stabilizers mechanisms and selection US Medical PG Question 4: A 32-year-old woman is brought to the physician by her husband, who is concerned about her ability to care for herself. Three weeks ago, she quit her marketing job to start a clothing company. Since then, she has not slept more than 4 hours per night because she has been working on her business plans. She used a significant portion of their savings to fund business trips to Switzerland in order to buy “only the best quality fabrics in the world.” She has not showered and has eaten little during the past 3 days. She has had 2 similar episodes a few years back that required hospitalization and treatment in a psychiatry unit. She has also suffered from periods of depression. She is currently not taking any medications. She appears unkempt and agitated, pacing up and down the room. She speaks very fast without interruption about her business ideas. She has no suicidal ideation or ideas of self-harm. Toxicology screening is negative. Which of the following is the most appropriate pharmacotherapy for the management of this patient?
- A. Clonazepam therapy for one year
- B. Long-term lithium therapy (Correct Answer)
- C. Sertraline therapy for one year
- D. Long-term risperidone therapy
- E. Long-term clozapine therapy
Mood stabilizers mechanisms and selection Explanation: ***Long-term lithium therapy***
- This patient presents with classic symptoms of **mania** (decreased need for sleep, grandiosity, compulsive spending, rapid speech) and a history of both manic and depressive episodes, consistent with **bipolar I disorder**.
- **Lithium** is a first-line agent for the **long-term maintenance treatment** of **bipolar I disorder**, particularly effective in preventing both manic and depressive episodes.
*Clonazepam therapy for one year*
- **Clonazepam** is a **benzodiazepine** primarily used for short-term management of acute agitation or severe insomnia, not for long-term mood stabilization in bipolar disorder.
- Long-term use of benzodiazepines carries risks of **tolerance** and **dependence**, making it inappropriate for chronic maintenance treatment.
*Sertraline therapy for one year*
- **Sertraline** is an **antidepressant** (SSRI) that, when used as monotherapy in bipolar disorder, can induce **mania** or **rapid cycling**.
- While periods of depression are mentioned, the current presentation is manic, and mood stabilizers are the priority for long-term management.
*Long-term risperidone therapy*
- **Risperidone** is a **second-generation antipsychotic** effective in treating acute mania and can be used for maintenance in bipolar disorder, often as an adjunct or in patients who cannot tolerate lithium.
- However, for long-term monotherapy in bipolar I disorder, **lithium** is generally considered more effective and is the preferred first-line agent, especially given the history of recurrent episodes.
*Long-term clozapine therapy*
- **Clozapine** is an **atypical antipsychotic** reserved for **treatment-resistant schizophrenia** and **refractory bipolar disorder**, often due to its significant side effect profile, including **agranulocytosis**.
- While it can be effective for severe or refractory cases of bipolar disorder, it is not a first-line long-term treatment given its risks and the availability of safer alternatives.
Mood stabilizers mechanisms and selection US Medical PG Question 5: A 28-year-old man is brought to the physician by his wife because she is worried about his unusual behavior. Two weeks ago, he was promoted and is now convinced that he will soon take over the firm. He has been working overtime at the office and spends most of his nights at parties. Whenever he comes home, he asks his wife to have sex with him and rarely sleeps more than 3 hours. He has a history of a similar episode and several periods of depression over the past 2 years. He currently takes no medications. He appears impatient, repeatedly jumps up from his seat, and says, "I have more important things to do." There is no evidence of suicidal ideation. Urine toxicology screening is negative. Long-term treatment with lithium is started. Which of the following endocrine parameters should be regularly monitored in this patient while he is undergoing treatment?
- A. Complete blood count with differential
- B. Serum creatinine
- C. Serum aminotransferases
- D. Serum thyroid-stimulating hormone (Correct Answer)
- E. Serum lithium levels
Mood stabilizers mechanisms and selection Explanation: ***Serum thyroid-stimulating hormone***
- **Lithium** can cause **hypothyroidism** due to its inhibitory effects on thyroid hormone synthesis and release, making it crucial to monitor **TSH** levels regularly.
- Long-term lithium use has been associated with a higher incidence of **goiter** and frank hypothyroidism, necessitating close endocrine surveillance.
*Complete blood count with differential*
- While **lithium** can cause **leukocytosis**, monitoring a CBC with differential is generally not a primary endocrine parameter for lithium toxicity.
- Neutrophilia is a common but usually benign side effect, not directly indicating endocrine dysfunction.
*Serum creatinine*
- **Lithium** is primarily excreted by the **kidneys**, and long-term use can lead to **chronic kidney disease** and nephrogenic diabetes insipidus, requiring monitoring of **serum creatinine**.
- Although essential for monitoring renal function, serum creatinine is a renal parameter, not an endocrine one.
*Serum aminotransferases*
- Monitoring **serum aminotransferases** (e.g., ALT, AST) is important for drugs that cause **hepatotoxicity**, but lithium is not primarily associated with significant liver damage.
- While liver function can be affected by various medications, it is not a specific or prominent endocrine side effect of lithium.
*Serum lithium levels*
- Monitoring **serum lithium levels** is critical to ensure therapeutic efficacy and prevent **toxicity**, as it has a narrow therapeutic window.
- While vital for patient safety, this is a direct drug level measurement, not an endocrine parameter reflecting hormonal function.
Mood stabilizers mechanisms and selection US Medical PG Question 6: A 37-year-old African American man is brought to the emergency department by police. The patient refused to leave a petting zoo after closing. He states that he has unique ideas to revolutionize the petting zoo experience. The patient has a past medical history of multiple suicide attempts. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 100/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient's cardiac and pulmonary exams are within normal limits. He denies any nausea, vomiting, shortness of breath, or systemic symptoms. The patient struggles to answer questions, as he is constantly changing the subject and speaking at a very rapid rate. The patient is kept in the emergency department overnight and is observed to not sleep and is very talkative with the nurses. Which of the following is the best long-term therapy for this patient?
- A. Haloperidol
- B. Lithium (Correct Answer)
- C. Diphenhydramine
- D. Valproic acid
- E. Risperidone
Mood stabilizers mechanisms and selection Explanation: ***Lithium***
- The patient exhibits classic symptoms of **mania**, including grandiosity, decreased need for sleep, pressured speech, and flight of ideas, suggesting **bipolar I disorder**.
- **Lithium** is considered a first-line agent and the best long-term maintenance therapy for **bipolar I disorder**, effective in reducing both manic and depressive episodes and decreasing suicide risk.
*Haloperidol*
- **Haloperidol** is a potent typical antipsychotic primarily used for acute management of severe agitation, psychosis, or manic episodes due to its rapid tranquilizing effects.
- While it could be used for immediate symptom control, it is not the **best long-term therapy** for mood stabilization in bipolar disorder and carries a high risk of **extrapyramidal side effects**.
*Diphenhydramine*
- **Diphenhydramine** is an antihistamine with sedative properties, sometimes used for mild insomnia or allergic reactions, but it has no role in the treatment of acute mania or the long-term management of bipolar disorder.
- It would not address the underlying mood dysregulation and behavioral symptoms seen in this patient's presentation.
*Valproic acid*
- **Valproic acid** (divalproex) is an effective mood stabilizer used for bipolar disorder, particularly in patients who cannot tolerate lithium or have rapid cycling.
- However, for long-term therapy and overall efficacy, especially considering lithium's proven benefits in reducing suicidality, **lithium** is generally considered the preferred first-line agent, although valproic acid is a strong alternative.
*Risperidone*
- **Risperidone** is an atypical antipsychotic, primarily used for acute mania or as an adjunct in bipolar depression, and in schizophrenia.
- While useful for acute symptom management of psychosis and agitation in bipolar disorder, it is not typically the sole **best long-term maintenance monotherapy** compared to mood stabilizers like lithium, which directly target the mood swings.
Mood stabilizers mechanisms and selection US Medical PG Question 7: A 28-year-old woman is brought to the emergency department by her friends. She is naked except for a blanket and speaking rapidly and incoherently. Her friends say that she was found watering her garden naked and refused to put on any clothes when they tried to make her do so, saying that she has accepted how beautiful she is inside and out. Her friends say she has also purchased a new car she can not afford. They are concerned about her, as they have never seen her behave this way before. For the past week, she has not shown up at work and has been acting ‘strangely’. They say she was extremely excited and has been calling them at odd hours of the night to tell them about her future plans. Which of the following drug mechanisms will help with the long-term management this patient’s symptoms?
- A. Inhibition of inositol monophosphatase and inositol polyphosphate 1-phosphatase (Correct Answer)
- B. Increase the concentration of dopamine and norepinephrine at the synaptic cleft
- C. Modulate the activity of gamma-aminobutyric acid receptors
- D. Acts as an antagonist at the dopamine, serotonin and adrenergic receptors
- E. Inhibit the reuptake of norepinephrine and serotonin from the presynaptic cleft
Mood stabilizers mechanisms and selection Explanation: ***Inhibition of inositol monophosphatase and inositol polyphosphate 1-phosphatase***
- The patient's symptoms (euphoria, grandiosity, reduced need for sleep, impulsivity, rapid speech, and unusual behavior) are classic for a **manic episode**, strongly suggesting **bipolar disorder**.
- **Lithium** is a mood stabilizer used for long-term management of bipolar disorder, and its primary molecular action is thought to involve the **inhibition of inositol phosphatases**, thereby depleting inositol and modulating intracellular signaling.
*Increase the concentration of dopamine and norepinephrine at the synaptic cleft*
- This mechanism describes the action of **stimulants** or some **antidepressants** (like TCAs or SNRIs), which could exacerbate manic symptoms in bipolar disorder.
- Increasing dopamine and norepinephrine would likely worsen the current patient's **hyperactivity**, **agitation**, and **psychosis**.
*Inhibit the reuptake norepinephrine and serotonin from the presynaptic cleft*
- This mechanism is characteristic of **antidepressants** (e.g., SSRIs, SNRIs) used to treat depression.
- Administering such drugs during a manic episode can precipitate or worsen **mania** or induce **rapid cycling** in bipolar patients.
*Modulate the activity of Ƴ-aminobutyric acid receptors*
- This describes the action of **benzodiazepines** or some **antiepileptic drugs** (e.g., valproate, lamotrigine).
- While some antiepileptic drugs (like valproate) are used as mood stabilizers, the direct modulation of GABA receptors to **increase GABAergic activity** (as with benzodiazepines) is typically for acute agitation and anxiety, not the primary long-term mood stabilization for bipolar disorder.
*Acts as an antagonist at the dopamine, serotonin, and adrenergic receptors*
- This mechanism generally describes the action of **antipsychotic medications** (e.g., olanzapine, quetiapine, risperidone).
- While antipsychotics are effective for acute mania and some are used in long-term maintenance of bipolar disorder, the question asks for the primary drug mechanism for long-term management which is **Lithium's mechanism of action**, targeting intracellular signaling rather than broad receptor antagonism.
Mood stabilizers mechanisms and selection US Medical PG Question 8: A 25-year-old woman is brought to the emergency department by EMS after being found naked in a busy downtown square. The patient stated that she is liberating people from material desires and was found destroying objects. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is deferred due to patient combativeness. The patient is given diphenhydramine and haloperidol and transferred to the psychiatric ward. On day 1 on the ward, the patient is no longer aggressive or agitated and has calmed down. She states that she feels severely depressed and wants to kill herself. The patient is started on a medication and monitored closely. On day 3 of the patient's stay in the hospital she is found in her room drawing up plans and states that she has major plans to revamp the current energy problems in the country. Which of the following is the most likely medication that was started in this patient?
- A. Quetiapine
- B. Olanzapine
- C. Lamotrigine
- D. Sertraline (Correct Answer)
- E. Lithium
Mood stabilizers mechanisms and selection Explanation: ***Sertraline***
- This patient exhibits classic **bipolar I disorder** with rapid mood cycling from **mania** (naked in public, grandiose delusions, destroying objects) to **severe depression** (suicidal ideation on Day 1) and back to **mania** (grandiose plans on Day 3).
- The key clinical clue is the **rapid return to mania by Day 3** after starting medication during the depressive phase. This suggests **antidepressant-induced mania/mood switch**, a well-known complication of using **SSRI antidepressants** (like sertraline) **without adequate mood stabilization** in bipolar disorder.
- **Antidepressants can precipitate manic episodes** within days in bipolar patients, which is why they should be avoided or used only with concomitant mood stabilizers. This question tests recognition of this critical psychiatric principle.
*Lithium*
- Lithium is a first-line **mood stabilizer** for bipolar disorder and would be appropriate for long-term management. However, lithium **prevents manic episodes** rather than causing them.
- Lithium takes **1-2 weeks to reach therapeutic levels**, so it would not explain the rapid mood switch to mania by Day 3. If lithium had been started, we would expect **stabilization or improvement**, not a return to mania.
*Quetiapine*
- Quetiapine is an **atypical antipsychotic** effective for both acute mania and bipolar depression. It can provide rapid mood stabilization.
- If quetiapine was started on Day 1, we would expect **mood stabilization or sedation**, not a switch back to mania. Quetiapine does **not precipitate manic episodes**.
*Olanzapine*
- Olanzapine is another **atypical antipsychotic** used for acute mania and maintenance in bipolar disorder.
- Like quetiapine, olanzapine would **stabilize mood** and reduce manic symptoms, not trigger them. It would not explain the return to mania on Day 3.
*Lamotrigine*
- Lamotrigine is a mood stabilizer particularly effective for **preventing depressive episodes** in bipolar disorder, though less effective for acute mania.
- Lamotrigine **does not precipitate manic episodes** and takes weeks to titrate to therapeutic doses due to risk of Stevens-Johnson syndrome. It would not explain the rapid mood switch observed here.
Mood stabilizers mechanisms and selection US Medical PG Question 9: A 21-year-old man presents to an outpatient psychiatrist with chief complaints of fatigue and “hearing voices.” He describes multiple voices which sometimes call his name or say nonsensical things to him before he falls asleep at night. He occasionally awakes to see “strange people” in his room, which frighten him but then disappear. The patient is particularly worried by this because his uncle developed schizophrenia when he was in his 20s. The patient also thinks he had a seizure a few days ago, saying he suddenly fell to the ground without warning, though he remembers the episode and denied any abnormal movements during it. He is in his 3rd year of college and used to be a top student, but has been getting C and D grades over the last year, as he has had trouble concentrating and fallen asleep during exams numerous times. He denies changes in mood and has continued to sleep 8 hours per night and eat 3 meals per day recently. Which of the following medications will be most beneficial for this patient?
- A. Haloperidol
- B. Valproic acid
- C. Risperidone
- D. Modafinil (Correct Answer)
- E. Levetiracetam
Mood stabilizers mechanisms and selection Explanation: ***Modafinil***
- This patient presents with **narcolepsy**, characterized by the **classic tetrad**: excessive daytime sleepiness (falling asleep during exams), **cataplexy** (sudden fall without loss of consciousness or abnormal movements), **hypnagogic hallucinations** (hearing voices before sleep), and **hypnopompic hallucinations** (seeing people upon awakening).
- The hallucinations are **not true psychotic symptoms** but rather dream-like phenomena occurring at sleep-wake transitions, which are common in narcolepsy.
- **Modafinil** is a first-line **wakefulness-promoting agent** that treats the excessive daytime sleepiness and improves alertness, addressing the primary pathology.
- The patient's family history of schizophrenia is a red herring; his symptoms are explained by narcolepsy, not a primary psychotic disorder.
*Risperidone*
- Risperidone is an **atypical antipsychotic** used for schizophrenia and other psychotic disorders.
- This patient does **not have a primary psychotic disorder**—the hallucinations are hypnagogic/hypnopompic phenomena associated with narcolepsy, not true psychotic hallucinations.
- Using an antipsychotic would be inappropriate and could **worsen daytime sleepiness** due to sedating effects, exacerbating the patient's core problem.
*Haloperidol*
- Haloperidol is a **first-generation antipsychotic** with significant risk of **extrapyramidal side effects**.
- Like risperidone, it would be inappropriate here as the patient does not have a psychotic disorder, and it would worsen sedation and daytime sleepiness.
*Valproic acid*
- Valproic acid is a **mood stabilizer and anticonvulsant** used for bipolar disorder and seizure disorders.
- The described "seizure" event is actually **cataplexy** (preserved consciousness, no abnormal movements), not a true seizure, so an anticonvulsant is not indicated.
- It would not address the narcolepsy symptoms and can cause sedation.
*Levetiracetam*
- Levetiracetam is an **anticonvulsant** medication.
- The patient's description (remembering the episode, no abnormal movements) is inconsistent with a seizure and consistent with **cataplexy**, which is treated by addressing the underlying narcolepsy, not with anticonvulsants.
Mood stabilizers mechanisms and selection US Medical PG Question 10: A 27-year-old man comes to the physician for a follow-up examination. Paroxetine therapy was initiated 6 weeks ago for a major depressive episode. He now feels much better and says he is delighted with his newfound energy. He gets around 8 hours of sleep nightly. His appetite has increased. Last year, he had two episodes of depressed mood, insomnia, and low energy during which he had interrupted his job training and stopped going to the gym. Now, he has been able to resume his job at a local bank. He also goes to the gym three times a week to work out and enjoys reading books again. His temperature is 36.5°C (97.7°F), pulse is 70/min, and blood pressure is 128/66 mm Hg. Physical and neurologic examinations show no abnormalities. On mental status examination, he describes his mood as "good." Which of the following is the most appropriate next step in management?
- A. Discontinue paroxetine
- B. Switch from paroxetine to venlafaxine therapy
- C. Continue paroxetine therapy for 6 months
- D. Continue paroxetine therapy for 2 years (Correct Answer)
- E. Switch from paroxetine to lithium therapy
Mood stabilizers mechanisms and selection Explanation: **Continue paroxetine therapy for 2 years**
- This patient has experienced **recurrent major depressive episodes**, with two episodes in the past year. Guidelines recommend continuing antidepressant therapy for **1-3 years or indefinitely** after a second or third episode to prevent relapse.
- Given his significant improvement and history of recurrent depression, long-term maintenance with paroxetine is the most appropriate strategy.
*Discontinue paroxetine*
- Discontinuing the antidepressant now would significantly increase the risk of a rapid **relapse** of major depressive disorder, especially given his history of multiple episodes.
- Antidepressants should not be abruptly stopped once symptoms resolve, particularly in patients with recurrent depression.
*Switch from paroxetine to venlafaxine therapy*
- There is no indication to switch to venlafaxine, as the patient has responded well to paroxetine and is currently in **remission**.
- Switching medications carries the risk of new side effects or a recurrence of depressive symptoms.
*Continue paroxetine therapy for 6 months*
- While 6 months of continuation therapy is standard after a **first episode** of major depressive disorder, it is insufficient for patients with **recurrent episodes**.
- Continuing for only 6 months heightens the risk of relapse for this patient given his history.
*Switch from paroxetine to lithium therapy*
- Lithium is typically used as a mood stabilizer for **bipolar disorder** or as an augmentation strategy for refractory depression.
- There is no evidence in the vignette to suggest bipolar disorder, and the patient has responded well to monotherapy with paroxetine.
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