Mental Health & Psychiatry — UKMLA MCQ

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HardMental Health & PsychiatryUKMLA

A 45-year-old with depression and chronic back pain requires an antidepressant that also helps neuropathic pain. Which class?

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Correct answer: B — SNRI (e.g. duloxetine)

Choose B — SNRI. Duloxetine is a serotonin–norepinephrine reuptake inhibitor that treats major depressive disorder and has established analgesic indications, including diabetic peripheral neuropathic pain and chronic musculoskeletal pain. SNRIs enhance descending inhibitory pain pathways via norepinephrine and serotonin reuptake blockade, making duloxetine the best single antidepressant choice when depression coexists with neuropathic-type chronic back pain. SSRIs, MAOIs, and mirtazapine are not preferred for neuropathic pain; TCAs can reduce neuropathic pain but are limited by anticholinergic, sedating, and cardiac adverse effects and are not the class exemplified by duloxetine.

Reference: DailyMed/FDA Prescribing Information: Duloxetine delayed-release capsules, updated 2026. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=9286ec0b-45ae-4a09-a0ad-556ec92aab63&type=display