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A 37-Year-Old Woman Comes to the Office Due to Difficulty

Question 629

Multiple Choice

A 37-year-old woman comes to the office due to difficulty sleeping for the past month.  She was involved in a motor vehicle crash 8 months ago and required extensive rehabilitation of her shoulder and left arm.  The patient reports difficulty sleeping and frequent nightmares about the event.  During the day, she is anxious and feels panicky whenever she recalls the crash.  She refuses to drive and instead has a friend transport her when necessary.  She declines offers from friends to talk about her feelings despite being visibly upset at times.
The patient has a history of gastroesophageal reflux disease treated with omeprazole.  Her father died at age 65 from a myocardial infarction and her mother has diabetes.  She works as an accountant but has been having difficulty concentrating and performing her job.  The patient has smoked a pack of cigarettes a day for the last 10 years but is trying to cut down.  She drinks 1 or 2 glasses of wine on weekends.
Physical examination is within normal limits.
Which of the following medications is likely to offer the most benefit for this patient?


A) Bupropion
B) Clonazepam
C) Mirtazapine
D) Sertraline
E) Trazodone

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