A 60-year-old man with major depression has prominent insomnia, poor appetite, and weight loss. Which antidepressant acts by blocking presynaptic alpha-2 adrenoceptors and histamine H1 receptors, making it particularly suited to this symptom profile?

• A Venlafaxine
• B Reboxetine
• C Vortioxetine
• D Mirtazapine ✓

Explanation

Mirtazapine antagonizes central alpha-2 autoreceptors and heteroreceptors, disinhibiting noradrenergic and serotonergic firing, and its strong H1 blockade produces sedation and increased appetite with weight gain, ideal for depressed patients with insomnia and cachexia. Venlafaxine is an SNRI that more often worsens insomnia and appetite, which kills the closest distractor.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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