Depression: antidepressant selection and management MCQs With Answer

Depression: antidepressant selection and management MCQs With Answer

This quiz set focuses on evidence-based selection and clinical management of antidepressants relevant to M.Pharm students studying Pharmacotherapeutics II (MPP 202T). Questions cover pharmacology, receptor profiles, pharmacokinetics, drug interactions, adverse effects, special populations, switching strategies, augmentation, treatment-resistant depression, and monitoring. Items are designed to test application-level knowledge—choosing therapy based on comorbidity, anticipating adverse outcomes, planning dose adjustments, and managing emergencies like serotonin syndrome. Use these MCQs to reinforce therapeutics decision-making, understand mechanism-driven side effect profiles, and prepare for clinical problem solving in pharmacotherapy of depressive disorders.

Q1. Which antidepressant is most appropriate for a patient with major depressive disorder who has significant insomnia and weight loss, and requires an agent with sedative and appetite-stimulating properties?

• Methylphenidate
• Fluoxetine
• Amitriptyline
• Mirtazapine

Correct Answer: Mirtazapine

Q2. Which mechanism best explains the risk of hypertensive crisis when a patient on an MAOI ingests tyramine-rich foods?

• Increased central serotonin release from MAOI interaction
• Peripheral inhibition of monoamine oxidase leading to excess norepinephrine
• Upregulation of beta-adrenergic receptors by MAOIs
• Direct alpha-2 receptor agonism increasing blood pressure

Correct Answer: Peripheral inhibition of monoamine oxidase leading to excess norepinephrine

Q3. Which SSRI has the longest half-life and therefore requires the least abrupt tapering to avoid discontinuation syndrome?

• Sertraline
• Paroxetine
• Fluoxetine
• Citalopram

Correct Answer: Fluoxetine

Q4. A patient stabilized on venlafaxine requires a switch to a MAOI. What is the minimum washout period recommended to reduce risk of serotonin syndrome?

• 7 days
• 14 days
• 5 days
• 2 days

Correct Answer: 14 days

Q5. Which antidepressant is preferred in depressed patients with coexisting neuropathic pain due to its dual noradrenergic and serotonergic reuptake inhibition?

• Bupropion
• Duloxetine
• Escitalopram
• Buspirone

Correct Answer: Duloxetine

Q6. Which antidepressant carries the highest risk of seizure at overdose and in patients with a seizure disorder?

• Bupropion
• Sertraline
• Venlafaxine
• Fluvoxamine

Correct Answer: Bupropion

Q7. For treatment-resistant depression, which augmentation strategy has strongest evidence as an initial pharmacologic augmenting agent?

• Adding lithium
• Adding high-dose benzodiazepine
• Adding amantadine
• Adding a statin

Correct Answer: Adding lithium

Q8. Which pharmacogenetic factor is most relevant when prescribing tricyclic antidepressants and some SSRIs due to altered metabolism risk?

• CYP3A5 gene deletion
• CYP2D6 polymorphism
• UGT1A1 promoter mutation
• MTHFR C677T variant

Correct Answer: CYP2D6 polymorphism

Q9. A patient on sertraline develops agitation, hyperreflexia, tremor, and fever after starting linezolid. What is the most likely cause?

• Neuroleptic malignant syndrome from sertraline
• Serotonin syndrome due to serotonergic interaction with MAOI activity of linezolid
• Anticholinergic toxicity from sertraline accumulation
• Hypertensive crisis from linezolid-tyramine interaction

Correct Answer: Serotonin syndrome due to serotonergic interaction with MAOI activity of linezolid

Q10. Which antidepressant is often chosen in depressed patients with prominent fatigue and lack of energy because it has activating properties and minimal sexual side effects?

• Mirtazapine
• Bupropion
• Paroxetine
• Imipramine

Correct Answer: Bupropion

Q11. When treating a pregnant woman with severe major depression, which antidepressant has the most evidence supporting relative safety in pregnancy, particularly in the second and third trimesters?

• Paroxetine
• Fluoxetine
• Phenelzine
• Valproate

Correct Answer: Fluoxetine

Q12. Which adverse effect is most characteristic of tricyclic antidepressants and limits use in elderly patients with BPH and glaucoma?

• Excessive sedation due to H1 blockade
• Anticholinergic effects causing urinary retention and blurred vision
• Sexual dysfunction due to serotonergic activity
• Orthostatic hypotension due to beta-2 blockade

Correct Answer: Anticholinergic effects causing urinary retention and blurred vision

Q13. Which monitoring parameter is most important when initiating or increasing dose of an SNRI like venlafaxine?

• Serum potassium
• Blood pressure
• Liver enzymes weekly
• Serum magnesium

Correct Answer: Blood pressure

Q14. Which description best reflects the recommended initial management timeline for antidepressant response in major depressive disorder?

• Full symptomatic remission is expected within 48–72 hours
• Some improvement often noted in 1–2 weeks, with maximal response by 6–8 weeks
• No improvement should be expected until at least 12 months of therapy
• Immediate mood elevation is typical; prolonged use is rarely needed

Correct Answer: Some improvement often noted in 1–2 weeks, with maximal response by 6–8 weeks

Q15. Which combination is contraindicated due to high risk of serotonin syndrome?

• Bupropion plus mirtazapine
• Fluoxetine plus linezolid
• Nortriptyline plus trazodone
• Sertraline plus quetiapine

Correct Answer: Fluoxetine plus linezolid

Q16. Which agent is primarily chosen when treating a depressed patient with comorbid smoking cessation goals and low risk for seizure?

• Bupropion
• Citalopram
• Phenelzine
• Clomipramine

Correct Answer: Bupropion

Q17. Which clinical sign differentiates serotonin syndrome from neuroleptic malignant syndrome (NMS)?

• Gradual onset over days to weeks
• Lead-pipe rigidity prominent in serotonin syndrome
• Hyperreflexia and clonus more typical of serotonin syndrome
• Elevated CPK only in serotonin syndrome

Correct Answer: Hyperreflexia and clonus more typical of serotonin syndrome

Q18. In elderly patients, which antidepressant strategy generally minimizes anticholinergic and orthostatic risks?

• Prefer tricyclic antidepressants at full doses
• Start low and go slow with SSRIs like sertraline or escitalopram
• Use high-dose MAOIs to avoid polypharmacy
• Combine two antidepressants immediately to achieve rapid response

Correct Answer: Start low and go slow with SSRIs like sertraline or escitalopram

Q19. Which property of trazodone makes it useful for depression accompanied by insomnia without heavy dependence liability?

• Strong GABA agonism producing dependence
• Potent dopamine reuptake inhibition
• 5-HT2A antagonism and H1 histamine blockade leading to sedation
• Alpha-2 adrenergic agonism producing long-term tolerance

Correct Answer: 5-HT2A antagonism and H1 histamine blockade leading to sedation

Q20. For a patient experiencing sexual dysfunction on an SSRI, which management option is evidence-based and commonly used?

• Increase SSRI dose to overcome sexual side effects
• Switch to or augment with bupropion
• Add a proton pump inhibitor
• Stop all antidepressants immediately without replacement

Correct Answer: Switch to or augment with bupropion

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