American Board of Family Medicine (ABFM) Practice Exam 2026 - Free ABFM Practice Questions and Study Guide

Duloxetine (Cymbalta) is the best pharmacologic agent in this scenario because it has dual action as both an antidepressant and a pain reliever. This medication is a serotonin-norepinephrine reuptake inhibitor (SNRI) and is particularly effective in managing chronic pain conditions such as fibromyalgia, neuropathic pain, and osteoarthritis while also alleviating symptoms of depression.

In older adults like the 70-year-old male in this case, the benefit of addressing both chronic pain and depressive symptoms simultaneously is crucial, as this can enhance overall quality of life and functional ability. Additionally, duloxetine has a favorable safety profile for older patients when monitoring is adhered to, making it a suitable option.

While other agents listed may also help manage depression, they may not adequately address the chronic pain aspect. Mirtazapine, for instance, is effective for depression and can help with sleep, but it may not significantly relieve chronic pain. Citalopram is an SSRI that is primarily used for depression and anxiety but does not have strong evidence for pain relief. Nortriptyline is a tricyclic antidepressant that is sometimes used for neuropathic pain, but it carries a higher risk of side effects