A 22-year-old woman with anorexia nervosa and a history of depression, for which she is currently taking bupropion, moves to a new city and presents to a local psychiatrist to establish care in her new location. She tells the doctor that she has been on the same dose of bupropion since she was 18 years old, and that her depression has been stable, but that she has lost 10 pounds over the last month and weighs only 90 pounds (41 kg) now with a height of 5 feet 5 inches (165 cm).
About which of the following complications should the physician be most concerned?
Correct Answer E:
Bupropion is an antidepressant that can lower the seizure threshold for some patients, and as a result should be discontinued or carefully monitored in a patient with anorexia nervosa. Patients with anorexia are at increased seizure risk related to large fluid shifts and electrolyte disturbances caused by binging and purging behavior.
The following are common side effects of SSRIs, except:
The most common side effects when taking SSRIs include headache, nausea, somnolence (drowsiness), weight/appetite fluctuations, changes in sexual behavior and increased feelings of anxiety or depression. These side effects are mostly present during the initial 1-4 weeks while the body adapts to the drug.
It is well documented that SSRIs can cause various sexual dysfunctions such as anorgasmia (inability to reach orgasm), diminished libido (sex drive) and erectile dysfunction or difficult/premature ejaculation in men. Such side effects have been found present in between 41% and 83% of patients responding to physician inquiry. These side effects occasionally disappear spontaneously without discontinuing use of the drug, and in most cases resolve themselves after stopping taking the SSRI.
The most frequently reported side effect of tricyclic antidepressants is:
Correct Answer E: Physicians use tricyclic antidepressants in the treatment of severe depression or depression that occurs with anxiety. Several also have broad anti-obsessional and anti-panic effects.
The anticholinergic effects of dry mouth, blurred vision, constipation, and difficulty in urination, postural hypotension, tachycardia, loss of sex drive, erectile failure, increased sensitivity to the sun, weight gain, sedation (sleepiness).
An anxious and agitated 18 year old white male presents to your office with a 2 hour history of severe muscle spasms in the neck and back. He was seen 2 days ago in a local emergency department with symptoms of gastroenteritis, treated with intravenous fluids, and sent home with a prescription for prochlorperazine /Compazine suppositories.
The best therapy for this problem is intravenous administration of:
Correct Answer A:
While rarely life threatening, an acute dystonic reaction can be frightening and painful to the patient and confusing to the treating physician who may be unaware of what medications the patient is taking. Dystonia can be caused by any agent that blocks dopamine, including prochlorperazine, metoclopramide, and typical neuroleptic agents such as haloperidol.
The treatment is to discontinue the offending agent. For the relief of an acute dystonic reaction, 1-2 mg of benztropine mesylate may be given IV, followed by 1-2 mg orally twice daily to prevent recurrence.
In a patient taking a selective serotonin reuptake inhibitor (SSRI), addition of bupropion (Welbutrin) should be considered if the patient develops with one of the following side effects?
Correct Answer D:
Antidepressants that inhibit serotoninergic reuptake have been reported to interfere with sexual function. Bupropion is a norepinephrine and dopamine reuptake inhibitor with essentially no direct serotonergic activity. Improvement in sexual functioning has been reported when sustained-release bupropion was either substituted for other antidepressants or added to a regimen of SSRIs.
Two recent studies have also shown that sustained-release bupropion was well tolerated in the treatment of sexual dysfunction in non-depressed women.
Click to expand