Mood disorders: tricyclic choice in elderly: 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.

Try it

Psychiatry · Mood disorders: tricyclic choice in elderly

Sample item

A frail 72-year-old with depression has marked postural hypotension and a history of falls. A tricyclic is considered because other drugs failed. Which tricyclic is relatively preferred in this setting?

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

The answer and the reasoning

B. Nortriptyline

Nortriptyline, a secondary amine, causes less postural hypotension and fewer anticholinergic effects than tertiary amine tricyclics such as amitriptyline and imipramine, so it is the usual tricyclic in older patients. Plasma level monitoring is possible.

Option by option

  • A. Clomipramine

    Clomipramine has strong anticholinergic and serotonergic effects and lowers the seizure threshold.

  • B. Nortriptyline (correct)

    Correct. Secondary amines like nortriptyline have milder hypotensive and anticholinergic effects.

  • C. Amitriptyline

    Amitriptyline is strongly sedating, anticholinergic and hypotensive, so it is a poor choice in the elderly.

  • D. Imipramine

    Imipramine is a tertiary amine with notable orthostatic hypotension.

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.

More Psychiatry questions

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Nortriptyline. Nortriptyline, a secondary amine, causes less postural hypotension and fewer anticholinergic effects than tertiary amine tricyclics such as amitriptyline and imipramine, so it is the usual tricyclic in older patients.

Why is "Clomipramine" not the answer?

Clomipramine has strong anticholinergic and serotonergic effects and lowers the seizure threshold.

Why is "Amitriptyline" not the answer?

Amitriptyline is strongly sedating, anticholinergic and hypotensive, so it is a poor choice in the elderly.

Why is "Imipramine" not the answer?

Imipramine is a tertiary amine with notable orthostatic hypotension.

What concept does this question test?

It tests Mood disorders: tricyclic choice in elderly in Psychiatry. Plasma level monitoring is possible.

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: tricyclic choice in elderly?

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.