Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) 4 Practice Exam

Choosing an antidepressant for major depressive disorder prioritizes safety and tolerability alongside efficacy. Selective serotonin reuptake inhibitors achieve mood improvement by increasing serotonin in the synapse while generally producing fewer anticholinergic and cardiovascular side effects than older drugs. They are also safer in overdose and, with usually once-daily dosing, tend to support better adherence. Because of this favorable balance, SSRIs are typically started first, and common options include fluoxetine, sertraline, citalopram, escitalopram, and fluvoxamine. Other classes can be effective, but they carry greater risks or tolerability concerns: older tricyclic antidepressants have significant anticholinergic effects and a higher overdose risk; monoamine oxidase inhibitors require strict dietary restrictions and have dangerous interactions; serotonin-norepinephrine reuptake inhibitors, while useful in certain patients, can bring more activating or hypertensive effects.