A 39-year-old woman with difficult-to-treat depression has tried all the antidepressant classes except MAOIs. She is currently taking an SSRI that will require a 5-week washout period before switching to an MAOI. Which of the following SSRIs is she currently taking?
Escitalopram (Lexapro)
Sertraline (Zoloft)
Fluoxetine (Prozac)
Paroxetine (Paxil)
The Correct Answer is C
Choice A reason: Escitalopram has a relatively short half-life and typically requires a 2-week washout period before initiating an MAOI to avoid serotonin syndrome.
Choice B reason: Sertraline also has a shorter half-life and does not require a 5-week washout. A 2-week period is generally sufficient.
Choice C reason: Fluoxetine has the longest half-life among SSRIs, with active metabolites that persist in the body for weeks. Due to this extended duration, a 5-week washout period is recommended before starting an MAOI to prevent serotonin toxicity.
Choice D reason: Paroxetine has a short half-life and would not necessitate a 5-week washout. A 2-week interval is typically adequate.
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Correct Answer is C
Explanation
Choice A reason: This response incorrectly implies that lack of efficacy from St. John's Wort precludes SSRI use. The concern is not efficacy overlap but the risk of serotonin syndrome due to additive serotonergic effects.
Choice B reason: This is incorrect and dangerous. St. John's Wort and SSRIs both increase serotonin levels, and their combination can lead to serotonin syndrome. They do not complement each other and should not be used together.
Choice C reason: This is the correct response. St. John's Wort has serotonergic properties and can interact with SSRIs, increasing the risk of serotonin syndrome. The combination is contraindicated due to the potential for life-threatening adverse effects.
Choice D reason: This response delays appropriate treatment and overlooks the safety concern. Continuing St. John's Wort while initiating an SSRI is unsafe and not recommended.
Correct Answer is C
Explanation
Choice A reason: Conversion disorder does not require that symptoms be consciously feigned. In fact, the symptoms are involuntary and not under conscious control. Misattributing intentionality would lead to a diagnosis of factitious disorder or malingering, not conversion disorder.
Choice B reason: Preoccupation with having or acquiring a serious illness is more characteristic of illness anxiety disorder, not somatic symptom disorder. SSD focuses on distress and behaviors related to actual somatic symptoms.
Choice C reason: Somatic symptom disorder is defined by the presence of one or more distressing somatic symptoms accompanied by excessive and disproportionate thoughts, feelings, or behaviors related to those symptoms. This cognitive-emotional preoccupation is the hallmark of SSD.
Choice D reason: La belle indifference may be observed in some cases of conversion disorder but is not a required diagnostic criterion. It refers to a paradoxical lack of concern about serious symptoms, but its absence does not rule out conversion disorder.
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