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Depression & Best Treatment Option

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Mary a 26 year of age Caucasian female is referred to you for depression. Given the severity of her symptoms, you and the patient agree that she should be treated with a combination of psychotherapy and pharmacotherapy. Mary has never been treated for depression before, but her aunt Debbie was successfully treated with Imipramine (Tofranil) and was able to tolerate the side effects very well. As you take the medical history, Mary informs you that there is a history in her family of cardiac arrhythmias, and that her heart "flutters" once in a while when she feels anxious. Given only this information, the best course of action is:

1) Start Mary on Imiprimine (Tofranil). Chances are that this medication will work for her.
2) Start Mary on Imiprimine (Tofranil) but also suggest that she receive a cardiac workup.
3) Start Mary on a high dose of Citalopram (Celexa) to control both depression and anxiety, and you may also suggest that she receive a cardiac workup.
4) Start Mary on a low dose of Citalopram (Celexa) and you also suggest that she receive a cardiac workup.

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Solution Summary

Given only the information in the scenario, the best course of action is chosen, along with an explanation of why it was chosen.