Antidepressants MCQs With Answer offers B. Pharm students a focused, exam-oriented review of antidepressant pharmacology. This concise guide emphasizes key topics: mechanisms of action, therapeutic uses, pharmacokinetics, major classes (SSRIs, SNRIs, TCAs, MAOIs, atypicals), adverse effects, CYP-mediated drug interactions, overdose management, serotonin syndrome, and monitoring. Questions probe receptor profiles, metabolic pathways, dosing considerations, and clinical safety for drugs like fluoxetine, amitriptyline, venlafaxine, and bupropion. Answers are provided to reinforce learning and clinical application. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which mechanism best describes how SSRIs exert their antidepressant effect?
- Enhancement of GABAergic neurotransmission
- Inhibition of serotonin reuptake at presynaptic transporters
- Blockade of NMDA receptors
- Inhibition of monoamine oxidase enzymes
Correct Answer: Inhibition of serotonin reuptake at presynaptic transporters
Q2. Which adverse effect is most characteristic of tricyclic antidepressants (TCAs)?
- Excessive serotonergic activation leading to sexual dysfunction
- Anticholinergic effects such as dry mouth and constipation
- Marked activation of dopamine receptors causing psychosis
- Serotonin and norepinephrine reuptake blockade without cardiovascular effects
Correct Answer: Anticholinergic effects such as dry mouth and constipation
Q3. Which antidepressant is associated with a high risk of seizures, particularly at higher doses?
- Escitalopram
- Bupropion
- Amitriptyline
- Sertraline
Correct Answer: Bupropion
Q4. A patient on an SSRI should avoid combining it with an MAOI because of the risk of:
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Excessive anticholinergic toxicity
- Hypertensive crisis due to tyramine interaction
Correct Answer: Serotonin syndrome
Q5. Which antidepressant has the longest half-life and may allow less frequent dosing or lower discontinuation syndrome risk?
- Fluoxetine
- Paroxetine
- Amitriptyline
- Venlafaxine
Correct Answer: Fluoxetine
Q6. Which drug class commonly causes orthostatic hypotension due to alpha-1 adrenergic blockade?
- SNRIs
- SSRIs
- TCAs
- Selective MAO-B inhibitors
Correct Answer: TCAs
Q7. Which antidepressant is a norepinephrine-dopamine reuptake inhibitor often used for smoking cessation support?
- Mirtazapine
- Bupropion
- Trazodone
- Phenelzine
Correct Answer: Bupropion
Q8. Which laboratory or clinical monitoring is most relevant when initiating lithium together with antidepressants?
- Serum potassium levels
- Liver enzyme panel only
- Serum lithium levels and renal function
- Blood glucose and HbA1c
Correct Answer: Serum lithium levels and renal function
Q9. Which antidepressant is particularly associated with QT prolongation and requires dose caution in patients with cardiac risk?
- Citalopram
- Fluvoxamine
- Milnacipran
- Imipramine
Correct Answer: Citalopram
Q10. Which enzyme system metabolizes many SSRIs and is a common source of drug interactions?
- Renal tubular secretion pathways
- Cytochrome P450 (CYP) enzymes
- Monoamine oxidase system
- P-glycoprotein only
Correct Answer: Cytochrome P450 (CYP) enzymes
Q11. Which antidepressant’s mechanism involves antagonism of central presynaptic alpha-2 adrenergic receptors, increasing noradrenergic and serotonergic transmission?
- Mirtazapine
- Sertraline
- Phenelzine
- Trazodone
Correct Answer: Mirtazapine
Q12. A hypertensive crisis with severe headache and sweating after ingesting aged cheese suggests which class interaction?
- SSRI with MAOI
- SNRI with TCA
- Tyramine-rich food with nonselective MAOI
- SSRI with St John’s wort
Correct Answer: Tyramine-rich food with nonselective MAOI
Q13. Which antidepressant is often chosen for patients with insomnia due to sedative and sleep-promoting properties?
- Fluoxetine
- Sertraline
- Trazodone
- Venlafaxine
Correct Answer: Trazodone
Q14. Discontinuation syndrome (withdrawal) is most common with which antidepressant characteristic?
- Long half-life and active metabolites
- Short half-life and abrupt cessation
- Low protein binding
- Primarily hepatic excretion
Correct Answer: Short half-life and abrupt cessation
Q15. Which drug is a reversible inhibitor of monoamine oxidase-A (RIMA) used less commonly but with lower dietary tyramine risk?
- Phenelzine
- Clorgyline
- Moclobemide
- Tranylcypromine
Correct Answer: Moclobemide
Q16. Which adverse effect is most commonly associated with SSRIs and often requires counseling but not discontinuation?
- Severe orthostatic hypotension
- Sexual dysfunction (decreased libido, anorgasmia)
- Marked anticholinergic delirium
- Extreme weight loss within days
Correct Answer: Sexual dysfunction (decreased libido, anorgasmia)
Q17. For bipolar depression, which antidepressant use is considered risky because it may precipitate mania if unopposed by a mood stabilizer?
- SSRIs without a mood stabilizer
- Bupropion with lithium
- MAOIs with valproate
- Mirtazapine with quetiapine
Correct Answer: SSRIs without a mood stabilizer
Q18. Which drug is an SNRI that at low doses acts mainly as an SSRI but at higher doses also inhibits norepinephrine reuptake?
- Venlafaxine
- Fluoxetine
- Imipramine
- Sertraline
Correct Answer: Venlafaxine
Q19. Which pharmacokinetic property increases the risk of interactions for fluvoxamine compared to other SSRIs?
- Minimal CYP inhibition
- Potent CYP1A2 and CYP3A4 inhibition
- Exclusively renal excretion
- High P-glycoprotein induction
Correct Answer: Potent CYP1A2 and CYP3A4 inhibition
Q20. Which antidepressant class is most likely to cause weight gain and sedation via histamine H1 antagonism?
- SSRIs
- MAOIs
- Tetracyclic/NaSSA (e.g., mirtazapine)
- SNRIs
Correct Answer: Tetracyclic/NaSSA (e.g., mirtazapine)
Q21. In a patient with hepatic impairment, which consideration is most important when prescribing antidepressants?
- No adjustment is ever needed for antidepressants
- Avoid drugs with extensive hepatic metabolism or reduce dose
- Always use MAOIs because they bypass the liver
- Increase dose due to decreased protein binding
Correct Answer: Avoid drugs with extensive hepatic metabolism or reduce dose
Q22. Which antidepressant has significant antagonism at 5-HT2A receptors and is often used for sexual side effect mitigation?
- Fluoxetine
- Trazodone
- Moclobemide
- Bupropion
Correct Answer: Trazodone
Q23. Which is the most appropriate initial counseling point for patients starting SSRIs regarding onset of antidepressant effect?
- Expect full therapeutic benefit within 24 hours
- Improvement may take 2–6 weeks; early side effects may occur
- Stop immediately if mild nausea occurs
- Never combine with psychotherapy
Correct Answer: Improvement may take 2–6 weeks; early side effects may occur
Q24. Which antidepressant is contraindicated in patients with an eating disorder due to increased seizure risk?
- Sertraline
- Fluvoxamine
- Bupropion
- Nortriptyline
Correct Answer: Bupropion
Q25. Which clinical sign is most suggestive of serotonin syndrome rather than simple SSRI side effects?
- Mild nausea and headache
- Bradycardia and hypotension only
- Hyperreflexia, clonus, and autonomic instability
- Dry mouth and constipation
Correct Answer: Hyperreflexia, clonus, and autonomic instability
Q26. Which antidepressant is considered relatively safe in pregnancy compared to older TCAs, with extensive safety data?
- Fluoxetine
- Moclobemide
- Imipramine
- Tranylcypromine
Correct Answer: Fluoxetine
Q27. Which mechanism explains why TCAs can cause cardiac conduction abnormalities in overdose?
- Blockade of fast sodium channels in cardiac myocytes
- Excessive serotonin reuptake inhibition only
- Stimulation of muscarinic receptors in the heart
- Inhibition of monoamine oxidase in cardiac tissue
Correct Answer: Blockade of fast sodium channels in cardiac myocytes
Q28. Which antidepressant is known for minimal sexual side effects and is sometimes used when SSRI-induced sexual dysfunction is problematic?
- Paroxetine
- Bupropion
- Fluoxetine
- Tranylcypromine
Correct Answer: Bupropion
Q29. If switching a patient from fluoxetine to an MAOI, what is the recommended washout period due to fluoxetine’s long half-life?
- No washout needed; switch immediately
- 2 weeks
- 5 weeks
- 24 hours
Correct Answer: 5 weeks
Q30. Which side effect profile best differentiates SNRIs from SSRIs at higher doses?
- Greater noradrenergic side effects such as increased blood pressure and tachycardia
- Less risk of nausea and sexual dysfunction
- Higher anticholinergic burden than TCAs
- Complete absence of withdrawal symptoms
Correct Answer: Greater noradrenergic side effects such as increased blood pressure and tachycardia
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