For treating a patient with symptoms of atypical depression, which medication would be the best choice?

The best choice for treating a patient with symptoms of atypical depression is phenelzine, which is a monoamine oxidase inhibitor (MAOI). Atypical depression is characterized by specific symptoms such as increased sleep and appetite, mood reactivity, and significant sensitivity to interpersonal rejection. These unique features often do not respond as well to standard selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants.

Phenelzine works by increasing the levels of norepinephrine, serotonin, and dopamine in the brain, which can be particularly effective for patients with atypical features. This medication is known to improve mood reactivity and can help alleviate the hypersensitivity to rejection that typifies atypical depression. Unlike some of the other treatment options, phenelzine has been specifically associated with benefits in patients with this type of depression.

While citalopram, a selective serotonin reuptake inhibitor, is frequently used for major depressive disorder, its effectiveness in atypical depression is generally lower compared to phenelzine. Lithium is primarily used as a mood stabilizer and is not typically indicated as first-line treatment for atypical depression. Desipramine, a tricyclic antidepressant, can be effective for some depressive