A 40-year-old man with recurrent major depression is distressed by sexual dysfunction and 6 kg weight gain from sertraline. He requests a switch to an agent unlikely to cause either problem. He has no history of seizures or eating disorder. Which drug is the most appropriate choice?

• A Mirtazapine
• B Paroxetine
• C Venlafaxine
• D Bupropion ✓

Explanation

Bupropion, a norepinephrine-dopamine reuptake inhibitor, causes minimal sexual dysfunction and is weight neutral or associated with weight loss, making it the standard choice when SSRI sexual adverse effects or weight gain are limiting. Mirtazapine causes both sedation and weight gain, paroxetine has among the highest rates of sexual dysfunction, and venlafaxine commonly causes sexual dysfunction and dose-dependent hypertension. Bupropion lowers seizure threshold, so the absence of seizure risk factors matters.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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