A 32-year-old woman with a history of major depressive disorder is started on escitalopram 10 mg daily. Three weeks later, she presents with decreased need for sleep (4 hours/night yet feels rested), increased energy, rapid speech, irritability, and impulsive online shopping spending over $3,000. She reports her mood is “amazing” and she has “never felt better.”

A 28-year-old patient with major depressive disorder (MDD) reports persistent low mood and anhedonia. You prescribe an SSRI. Two weeks later, the patient asks how the medication is helping their brain function. Which explanation is most accurate?

A 17-year-old girl started fluoxetine 2 weeks ago for depression. Her mood is slightly better, but she now reports passive suicidal thoughts without a plan or intent.  

A 33-year-old patient with depression and obesity is concerned about weight gain with antidepressants. Which medication would be the most appropriate to minimize weight gain and potentially promote weight loss?

A provider is considering starting bupropion for depression given its favorable side effect profile regarding sexual dysfunction and weight gain.Which patient has an absolute contraindication to bupropion?

A 42-year-old patient with MDD and chronic insomnia reports difficulty initiating and maintaining sleep. You want to select an antidepressant that may also improve sleep. Which is the best option?

A 45-year-old woman is prescribed zolpidem for insomnia. What is the most important instruction to give her?

A patient develops tardive dyskinesia from long-term antipsychotic use. Which of the following medications is FDA-approved for the treatment of tardive dyskinesia?

A 32-year-old woman taking lamotrigine for bipolar disorder develops a new rash on her body. She has no fever or other symptoms. What is the best next step?

A 25-year-old patient presents to the ED with sustained neck contraction and upward eye deviation shortly after starting a high-potency antipsychotic. What is the best immediate treatment?