Which second-line drug is typically avoided in cases of uncontrolled depression?

Cycloserine is the second-line drug that is typically avoided in cases of uncontrolled depression due to its potential neuropsychiatric side effects. This drug can lead to a range of psychiatric issues, including anxiety, depression, and even more severe manifestations such as psychotic symptoms, especially in patients who have pre-existing mental health conditions.

Given the risk that cycloserine poses to individuals with uncontrolled depression, health care providers often seek alternative treatments to minimize the possibility of exacerbating the patient’s mental health status. In contrast, drugs like levofloxacin, clofazimine, and ethambutol have different side effect profiles and are not specifically associated with worsening depression, making them safer options for patients with this condition.

The awareness of the neuropsychiatric side effects associated with cycloserine underscores the importance of assessing a patient's mental health history before initiating treatment, ensuring that the chosen medication supports both physical and mental well-being in the management of tuberculosis.