Skip to Main Content

Chapter 38. Major Depressive Disorder

Student Questions

Which of the following SSRIs requires up to a 5-week washout period prior to starting an MAOI because of the long half-life of its potent active metabolite?

A. Escitalopram

B. Fluvoxamine

C. Fluoxetine

D. Sertraline

Answer: C

Option A: Incorrect. A 2-week washout is sufficient for escitalopram.

Option B: Incorrect. A 2-week washout is sufficient for fluvoxamine.

Option C: Correct. The elimination half-life for fluoxetine is 4 to 6 days and 4 to 16 days with chronic dosing which (includes the active metabolite). Due to the long half-life, a 5-week washout is required after discontinuing fluoxetine before starting an MAOI.

Option D: Incorrect. A 2-week washout is sufficient for sertraline.

Which of the following symptoms is most likely to improve within approximately 1 to 2 weeks of starting treatment?

A. Depressed mood

B. Suicidal thoughts

C. Anhedonia

D. Sleep

Answer: D

Option A: Incorrect. Full improvement in mood may take 2 to 4 weeks and possibly 6 to 8 weeks for full symptom improvement.

Option B: Incorrect. As with mood, suicidal thoughts may take 2 to 4 weeks and possibly 6 to 8 weeks for full symptom improvement. There is a possibility that suicidal ideations may worsen with antidepressant therapy as outlined in all antidepressant's black box warning information.

Option C: Incorrect. Anhedonia may take 2 to 4 weeks and possibly 6 to 8 weeks for full symptom improvement.

Option D: Correct. Improvement in physical symptoms, such as sleep, appetite, and energy, can occur within the first or second week of treatment.

Which of the following is dangerous to combine with an MAOI?

A. Lorazepam

B. Acetaminophen

C. Meperidine

D. Ziprasidone

Answer: C

Option A: Incorrect. There is no significant drug interaction between lorazepam and MAOIs.

Option B: Incorrect. There is no significant drug interaction between acetaminophen and MAOIs.

Option C: Correct. There is a significant risk of serotonin syndrome when meperidine is combined with an MAOI.

Option D: Incorrect. There is no significant drug interaction ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.