Mood disorders: switching from fluoxetine to an MAOI: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Mood disorders: switching from fluoxetine to an MAOI

Sample item

A patient with depression has not responded to fluoxetine and the doctor wishes to start an irreversible MAOI. Why must a long washout of several weeks be left after stopping fluoxetine first?

AFluoxetine blocks absorption of the MAOIBIts active metabolite norfluoxetine persists and may cause serotonin syndromeCFluoxetine induces tyramine releaseDFluoxetine irreversibly destroys MAO enzyme

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Its active metabolite norfluoxetine persists and may cause serotonin syndrome

Fluoxetine and norfluoxetine have long half-lives, so serotonergic activity remains for weeks after the last dose. Starting an MAOI too early can precipitate serotonin syndrome, and a gap of about five weeks is advised.

Option by option

A. Fluoxetine blocks absorption of the MAOI
Fluoxetine does not block absorption of MAOIs.
B. Its active metabolite norfluoxetine persists and may cause serotonin syndrome (correct)
Correct. Persistent norfluoxetine plus an MAOI risks serotonin syndrome.
C. Fluoxetine induces tyramine release
Fluoxetine does not release tyramine; tyramine reactions come from food with MAOIs.
D. Fluoxetine irreversibly destroys MAO enzyme
Fluoxetine does not inhibit MAO irreversibly; the washout concerns serotonin excess.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Its active metabolite norfluoxetine persists and may cause serotonin syndrome. Fluoxetine and norfluoxetine have long half-lives, so serotonergic activity remains for weeks after the last dose.

Why is "Fluoxetine blocks absorption of the MAOI" not the answer?

Fluoxetine does not block absorption of MAOIs.

Why is "Fluoxetine induces tyramine release" not the answer?

Fluoxetine does not release tyramine; tyramine reactions come from food with MAOIs.

Why is "Fluoxetine irreversibly destroys MAO enzyme" not the answer?

Fluoxetine does not inhibit MAO irreversibly; the washout concerns serotonin excess.

What concept does this question test?

It tests Mood disorders: switching from fluoxetine to an MAOI in Psychiatry. Starting an MAOI too early can precipitate serotonin syndrome, and a gap of about five weeks is advised.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Mood disorders: switching from fluoxetine to an MAOI?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.