1. Which of the following is a symptom of major depressive disorder?

2. Which of the following are first-line agents for major depressive disorder?

3. Which of the following should be monitored in a patient prescribed venlafaxine?

4. Which of the following side effects commonly occurs and should be discussed when counseling about amitriptyline?

5. Of the DSM-5 diagnostic criteria for major depressive disorder, how many symptoms of depression is this patient presenting with?

6. Which of the following is an appropriate first-line pharmacologic recommendation for this patient?

7. The patient should be counseled about which Black Box Warning when initiated on an antidepressant?

8. The patient is concerned with how long it will take the medication to work. He is worried his girlfriend will leave before he “gets better.” What length of time would he likely begin to see a relief of sadness?

9. While discussing timeframes for the antidepressant to work, the patient asks what will likely change first in his depressive presentation. He would like to let his girlfriend know what to look for so they know the medication is working. Which symptom is likely to improve first after beginning antidepressive therapy?

10. After a few days of taking escitalopram 20 mg a day, the patient calls the primary care physician's office complaining of side effects. He reports he has been taking the medication as prescribed every morning but has been feeling “jittery” ever since he started the medication. Which common antidepressant side effect is the patient experiencing?

11. Now that the patient is experiencing side effects from his antidepressant, he has begun expressing he might just stop taking the medication. Which of the following is the best option to minimize the “jittery” side effect and help the patient be adherent?

12. The patient returns to his primary care physician's office five weeks later for a follow-up visit. A lot has occurred in the meantime, and the physician decided to switch him to sertraline. He is now taking sertraline 50 mg po daily, and has been on it for about 4 weeks. He indicates his performance and energy at work have improved, he is feeling less guilty about being a burden on his coworkers, and is sleeping better. However, he still feels sad most of the time, doesn't experience pleasure, and his relationship with his girlfriend is still “on the rocks.” What is an appropriate next step for this patient?

13. During the patient's eight week follow-up visit, he indicates he is feeling “much better” and feels his relationship with his girlfriend has really improved. However, he has noticed since he began his antidepressant he has been experiencing delayed ejaculation during sex. He feels at this point in their relationship, intimacy is very important to keep them “on the right track” and would like to try a different medication. Which medication would you recommend that the patient be switched to?

14. The patient returns to his primary care physician's office for a 6-month follow-up visit and indicates he is feeling “great.” He reports he is sleeping well and able to focus at work. His relationship with his girlfriend is back to “normal” and he confides he will be proposing next week. Because he is feeling well at this point in time, he is wondering when he can stop antidepressant therapy. How long must the patient be symptom free before he may begin a trial to taper off antidepressant therapy?

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