Which antidepressant would you recommend for a woman aged 47 years who presents with depressed mood, low energy, decreased motivation and hypersomnia? The patient is overweight, has elevated liver enzymes and a history for binge drinking. She recently stopped smoking using varenicline (Chantix). She is also being evaluated for possible multiple sclerosis. — Amy A. Payson, EdD, APRN, CNS-BC, PMHNP-BC, Trumball, Conn.

This patient is presenting with classic symptoms of depression and would likely respond well to bupropion (Wellbutrin). This drug is indicated for the treatment of depression and seasonal affective disorder. Bupropion is also used to decrease cravings and helps people to stop smoking. In the brain, bupropion blocks noradrenergic reuptake and dopaminergic reuptake.

Dopamine, a neurotransmitter, is involved with feelings of enjoyment and pleasure and increases motivation. A person who is dopamine-deficient will often complain of depression, fatigue and decreased motivation. Bupropion is contraindicated in patients with a history of seizure disorder, bulimia and anorexia nervosa.

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For patients with hepatic cirrhosis or renal impairment, consideration should be given for reduced dosing. Patients with chronic medical problems are at risk for depression and should be treated appropriately. — Eileen F. Campbell, MSN, CRNP (156-2)