MH701 ACTUAL EXAM SCRIPT 2026
QUESTIONS AND SOLUTIONS GRADED
A+.
■ What is a common mistake leading to unsuccessful antidepressant
drug trial? Answer- Not giving it enough time.
■ Major depression is? Answer- 5 or more of the following symptoms
in the same 2 week period with at least 1 being depressed mood or loss
of interest or pleasure.
SIGECAPS
S: Sleep changes.
I: interest loss.
G: Guilt or worthlessness.
E: Energy lack.
C: Concentration /cognition reduced.
A: Appetite usually declined.
P: Psychomotor retardation.
S: Suicidal or homicidal ideation.
■ Dysthymia is? Answer- Persistent depressive symptoms lasting 2
years.
,■ What role does serotonin have in the different aspect of depression?
Answer- Serotonin regulates mood, sleep, appetite, pain, sex, instincts.
Too much or too little can cause depression or apathy.
■ What is the patient education to any patient starting an antidepressant?
Answer- * Takes 2-6 weeks to see a response
* Can increase suicidal ideation
* SE: sexual dysfunction, GI upset, activation, sedation, insomnia,
headaches
* Serotonin syndrome -
* Do not abruptly stop medication, it must be slowly titrated down
■ What is serotonin syndrome? Answer- Serotonin syndrome -
abdominal pain, diarrhea, flushing, diaphoresis, hyperthermia, mental
status changes. renal failure, rhabdomyolysis, cardiovascular shock,
death
■ Which of the SSRIs has an indication for the treatment of bulimia to
decrease binging patterns? Answer- Fluoxetine (Prozac)
■ Mechanism and action of SSRI:. Answer- - inhibit the reuptake of
serotonin, thereby increasing serotonin activity; have little effect on
other neurotransmitters, such as dopamine or norepinephrine
,■ Mechanism and action of SNRI:. Answer- -inhibit the reuptake of the
neurotransmitters serotonin and norepinephrine, which increases
extracellular concentrations of serotonin and norepinephrine and,
consequently, an increase in neurotransmission.
■ Discontinuation syndrome: Risk factors:. Answer- * Extended therapy
of SSRI
* Paroxetine bigger offender, then sertraline, citalopram, escitalopram
* Fluoxetine less likely to occur due to long half life
* Taper over several weeks to minimize discontinuation symptoms
■ Discontinuation syndrome: symptoms. Answer- * Flu-like: Chills,
body aches, nausea, headache, lightheadedness
* Neurological symptoms : paresthesia's, insomnia, electro-shock like
phenomena
■ Sexual side effects of SSRI's and possible intervention:. Answer-
Women can be anorgasmic and men have erectile dysfunction.
Bupropion (Wellbutrin) can reduce sexual side effects.
■ Which SSRI has the highest risk of drug-drug interactions due to CYP
enzymes? Answer- Most Problematic - Paroxetine, followed by
fluoxetine - Significant effects on CYP2D6
Least Problematic - Sertraline, Citalopram, and Escitalopram
, ■ Mechanism of action of TCA's:. Answer- TCA's: Increase levels of NE
and SE. They do this by interfering with reuptake of them at the synapse.
However they also affect many other neurotransmitters, hence all the SE.
■ What are the most concerning side effects of TCA's? Answer-
Sedation, cardiac and anticholinergic.
* Anticholinergic side-effects: dry mouth, constipation, blurred vision,
urinary retention, delirium
* Cardiac : tachycardia, arrhythmias, orthostatic hypotension
More lethal in overdose - cardiac arrhythmias. Monitor blood levels to
prevent cardiac toxicity
* Sedation: increased SS risk
■ Risks with patients being on a TCA? Answer- Cardiac arrhythmias
which can be lethal
■ Mechanism of action of MAOIs:. Answer- Monoamine oxidase is
originally responsible for inhibiting the action of norepinephrine,
dopamine, and serotonin. Therefore blocking its action allows for more
to be available in the body. These are JUST AS EFFECTIVE AS SSRI'S
BUT HAVE MORE SERIOUS ADVERSE EFFECTS AND
INTERACTIONS.
QUESTIONS AND SOLUTIONS GRADED
A+.
■ What is a common mistake leading to unsuccessful antidepressant
drug trial? Answer- Not giving it enough time.
■ Major depression is? Answer- 5 or more of the following symptoms
in the same 2 week period with at least 1 being depressed mood or loss
of interest or pleasure.
SIGECAPS
S: Sleep changes.
I: interest loss.
G: Guilt or worthlessness.
E: Energy lack.
C: Concentration /cognition reduced.
A: Appetite usually declined.
P: Psychomotor retardation.
S: Suicidal or homicidal ideation.
■ Dysthymia is? Answer- Persistent depressive symptoms lasting 2
years.
,■ What role does serotonin have in the different aspect of depression?
Answer- Serotonin regulates mood, sleep, appetite, pain, sex, instincts.
Too much or too little can cause depression or apathy.
■ What is the patient education to any patient starting an antidepressant?
Answer- * Takes 2-6 weeks to see a response
* Can increase suicidal ideation
* SE: sexual dysfunction, GI upset, activation, sedation, insomnia,
headaches
* Serotonin syndrome -
* Do not abruptly stop medication, it must be slowly titrated down
■ What is serotonin syndrome? Answer- Serotonin syndrome -
abdominal pain, diarrhea, flushing, diaphoresis, hyperthermia, mental
status changes. renal failure, rhabdomyolysis, cardiovascular shock,
death
■ Which of the SSRIs has an indication for the treatment of bulimia to
decrease binging patterns? Answer- Fluoxetine (Prozac)
■ Mechanism and action of SSRI:. Answer- - inhibit the reuptake of
serotonin, thereby increasing serotonin activity; have little effect on
other neurotransmitters, such as dopamine or norepinephrine
,■ Mechanism and action of SNRI:. Answer- -inhibit the reuptake of the
neurotransmitters serotonin and norepinephrine, which increases
extracellular concentrations of serotonin and norepinephrine and,
consequently, an increase in neurotransmission.
■ Discontinuation syndrome: Risk factors:. Answer- * Extended therapy
of SSRI
* Paroxetine bigger offender, then sertraline, citalopram, escitalopram
* Fluoxetine less likely to occur due to long half life
* Taper over several weeks to minimize discontinuation symptoms
■ Discontinuation syndrome: symptoms. Answer- * Flu-like: Chills,
body aches, nausea, headache, lightheadedness
* Neurological symptoms : paresthesia's, insomnia, electro-shock like
phenomena
■ Sexual side effects of SSRI's and possible intervention:. Answer-
Women can be anorgasmic and men have erectile dysfunction.
Bupropion (Wellbutrin) can reduce sexual side effects.
■ Which SSRI has the highest risk of drug-drug interactions due to CYP
enzymes? Answer- Most Problematic - Paroxetine, followed by
fluoxetine - Significant effects on CYP2D6
Least Problematic - Sertraline, Citalopram, and Escitalopram
, ■ Mechanism of action of TCA's:. Answer- TCA's: Increase levels of NE
and SE. They do this by interfering with reuptake of them at the synapse.
However they also affect many other neurotransmitters, hence all the SE.
■ What are the most concerning side effects of TCA's? Answer-
Sedation, cardiac and anticholinergic.
* Anticholinergic side-effects: dry mouth, constipation, blurred vision,
urinary retention, delirium
* Cardiac : tachycardia, arrhythmias, orthostatic hypotension
More lethal in overdose - cardiac arrhythmias. Monitor blood levels to
prevent cardiac toxicity
* Sedation: increased SS risk
■ Risks with patients being on a TCA? Answer- Cardiac arrhythmias
which can be lethal
■ Mechanism of action of MAOIs:. Answer- Monoamine oxidase is
originally responsible for inhibiting the action of norepinephrine,
dopamine, and serotonin. Therefore blocking its action allows for more
to be available in the body. These are JUST AS EFFECTIVE AS SSRI'S
BUT HAVE MORE SERIOUS ADVERSE EFFECTS AND
INTERACTIONS.
