American Board of Family Medicine (ABFM) Practice Exam 2025 - Free ABFM Practice Questions and Study Guide

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A patient with obesity, diabetes, peripheral neuropathy, and a seizure disorder has been newly diagnosed with depression. Which medication is recommended?

Bupropion

Citalopram

Duloxetine

Duloxetine is recommended in this scenario due to its dual action as both a serotonin-norepinephrine reuptake inhibitor (SNRI) and its benefits for patients with certain conditions like diabetes and neuropathy. It has been shown to help manage depression while also providing significant relief for neuropathic pain, which is particularly beneficial for someone with peripheral neuropathy.

Additionally, Duloxetine does not carry the same risks of seizure as bupropion, making it suitable for patients with a seizure disorder. Unlike nortriptyline, which is a tricyclic antidepressant often avoided in patients with obesity due to its anticholinergic side effects and risks of weight gain, Duloxetine is weight-neutral or may even aid in weight management, aligning well with the patient's obesity. While citalopram is also an effective antidepressant, it does not address the neuropathic pain component, which is a significant concern in this patient’s case.

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Nortriptyline

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