Today’s question will test your understanding of the fundamentals of psychopharmacology.
I’m Paul Ciurysek, MD, and this is The USMLE Times: An independent, subscriber-supported newsletter designed to help you survive medical school, pass your USMLE exams, and match into your dream residency program.
A 27-year-old primigravida presents to her obstetrician's office for her 6-week postpartum checkup. She reports that, over the past three weeks, she has been experiencing persistent feelings of sadness, guilt, and difficulty bonding with her newborn. She also complains of poor appetite, difficulty sleeping, and a lack of interest in daily activities. She denies any history of depression or psychiatric illness. The patient is currently breastfeeding her baby and wishes to continue doing so. She is concerned about her symptoms and asks for help. Which of the following treatment options is most appropriate for this patient, given her desire to continue breastfeeding?
A) Fluoxetine
B) Lorazepam
C) Imipramine
D) Bupropion
E) Venlafaxine
F) Sertraline
Detailed Breakdown of Answers + Correct Answer Below ⏬
ANSWER + QUESTION BREAKDOWN
The mental model used to answer this question comes from our detailed test-taking skills masterclass. Here’s how to think through this question:
Step 1. Read the last line to determine what the question is asking: Identify which medication is most appropriate for this patient.
Step 2: Is this a first-, second-, or third-order question?
Answer: 2nd order: Recognize the need for a specific medication and know which medication best suits the post-partum patient.
Step 3. Read the vignette to gather information.
Step 4. Consider what’s being asked and derive your answer.
Step 5. Look at the answer choices and select the option most closely resembling your thoughts from “Step 4” above.
GENERAL ANALYSIS
This question involves a 27-year-old woman experiencing symptoms of postpartum depression six weeks after giving birth. She wishes to continue breastfeeding and seeks treatment for her symptoms. The task is to identify the most appropriate antidepressant that is effective for her condition and safe for her infant during breastfeeding.
ANSWER CHOICES:
ANSWER CHOICE A: Fluoxetine
Fluoxetine has a long half-life and higher levels in breast milk, which can lead to accumulation in infants, making it less ideal for breastfeeding mothers.
ANSWER CHOICE B: Lorazepam
Lorazepam is a benzodiazepine used for anxiety; it is not an antidepressant and is not a primary treatment for postpartum depression.
ANSWER CHOICE C: Imipramine
Imipramine is a TCA, which is not the first choice for postpartum depression due to potential side effects and concerns about infant exposure through breast milk.
ANSWER CHOICE D: Bupropion
Bupropion is an atypical antidepressant used for depression. However, there is limited data on breastfeeding compared to the more appropriate option.
ANSWER CHOICE E: Venlafaxine
Venlafaxine is an SNRI. While it can be effective for depression, it is not the first-line treatment recommended in the post-partum period due to a lack of extensive data supporting its safety.
ANSWER CHOICE F: Sertraline
Sertraline is considered the preferred SSRI for breastfeeding mothers due to its low excretion into breast milk and minimal infant exposure, making it a safe and effective choice for postpartum depression.
FINAL VERDICT…
Sertraline is the recommended SSRI for treating postpartum depression in breastfeeding mothers. It has a favorable safety profile, with low levels of excretion into breast milk and minimal detectable levels in infants. This makes it an effective and safe option for managing the mother's depression while minimizing the risk to the breastfeeding infant. Given the patient's desire to continue breastfeeding, sertraline is the most appropriate choice for her treatment.
CORRECT ANSWER: F) Sertraline
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