A 52-year-old man develops a major depressive episode four weeks after an acute myocardial infarction. His cardiologist wants pharmacological treatment with the best documented safety data in post-infarction patients. Which antidepressant should be chosen?

• A Amitriptyline
• B Bupropion
• C Phenelzine
• D Sertraline ✓

Explanation

Sertraline has randomised trial evidence in post-myocardial infarction patients showing safety and efficacy without significant effects on cardiac conduction or ejection fraction, making it the conventional SSRI of choice in cardiac patients. Amitriptyline is contraindicated because tricyclics prolong QT, slow conduction, and are proarrhythmic in ischaemic heart disease. Phenelzine risks hypertensive crises. Bupropion raises blood pressure and heart rate and lacks comparable post-infarction trial data.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.