A 55-year-old woman with chronic renal failure on haemodialysis develops persistent depressive symptoms. Which antidepressant should be used with GREATEST caution in this patient due to active metabolite accumulation?
- A Sertraline
- B Venlafaxine
- C Bupropion ✓
- D Mirtazapine
Correct answer: C. Bupropion
Explanation
Bupropion and its active metabolite hydroxybupropion accumulate in renal failure, lowering the seizure threshold and increasing seizure risk. Sertraline is preferred in CKD/ESRD with minimal dose adjustment needed. Venlafaxine requires dose reduction but can be used. Mirtazapine is relatively safe in renal impairment. Bupropion is contraindicated in severe renal impairment.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.