WBR1137

Author	[[PageAuthor::Pratik Bahekar, MBBS [1]]]
Exam Type	USMLE Step 2 CK
Main Category	Psychiatry
Sub Category	Psychiatry, Ethics
Prompt	36 year old man comes to a primary care doctor, with complains of depressed mood and loss of interest from last 7 months when he lost his wife in a car accident. On examinations, his vitals were stable and lab reports were, Hb 14 AST 12 U/L ALT 14 U/L ALP 15 U/L Total bilirubin 0.6 mg/dl BUN 14 mg/dL The dexamethasone suppression test did not reveal an adrenal axis pathology, also TSH was normal. His mood brightened when he learns about positive events. He had a 20 pound weight gain in last 6 months and sleeping 10 hours a day. Also, he described a heavy feeling in his arms and legs. What is the next step in the management?
Answer A	Prescribe Selegiline
Answer A Explanation	This a case of atypical depression, it is treated by MAOIs.
Answer B	Prescribe Doxepine
Answer B Explanation	MAOIs not Doxepine is first line treatment for atypical depression.
Answer C	Prescribe Lithium
Answer C Explanation	Lithium is a mood stabilizer, this patient does not have features of bipolar disorder.
Answer D	Prescribe Risperidone
Answer D Explanation	Risperidone is an antipsychotic, not used in the treatment of atypical depression.
Answer E	Prescribe Buspirone
Answer E Explanation	Buspirone is useful for treating depression with features of anxiety.
Right Answer	A
Explanation	This a case of atypical depression, it is treated by MAOIs. Educational Objective: References: pg 510 MTB-CK
Approved	No
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