A 68-year-old man with advanced pancreatic cancer develops severe depression. Which antidepressant is preferred in this setting due to its fast onset, low drug interaction profile, and tolerability in medically ill patients?

• A Amitriptyline
• B Phenelzine
• C Tranylcypromine
• D Mirtazapine ✓

Explanation

Mirtazapine is preferred in medically ill patients with depression, particularly those with cancer-related cachexia, anorexia, insomnia, and nausea. It acts via alpha-2 antagonism and 5-HT2/5-HT3 blockade, providing appetite stimulation, antiemetic effect, and sedation at low doses (7.5–15 mg). Its onset of clinical effect (1–2 weeks) is faster than SSRIs. Amitriptyline is poorly tolerated in elderly/medically ill due to anticholinergic burden. MAOIs (phenelzine, tranylcypromine) have serious interaction potential with opioids and other medications.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.