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Major Depressive Disorder — USMLE Step 2 CK MCQ

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EasyPsychiatryMajor Depressive DisorderUSMLE Step 2 CK

A 36-year-old woman has 7 weeks of depressed mood, loss of interest, impaired concentration, insomnia, guilt, and low energy that interfere with work. She has no mania, psychosis, substance use, or suicidal intent. Major depressive disorder of moderate severity is diagnosed. After discussing psychotherapy and medication, she prefers medication and has no contraindication. Which initial treatment is most appropriate?

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Correct answer: C — Begin a second-generation antidepressant such as sertraline

A second-generation antidepressant such as sertraline is an appropriate initial monotherapy for moderate major depressive disorder when the informed patient prefers medication. Cognitive behavioral therapy is also a recommended first-line option, and combination therapy may be considered according to severity, response, access, and preference, but it is not necessary to override her stated choice. Reassurance alone leaves a functionally impairing depressive episode untreated. Benzodiazepines do not treat core depression and create risks of dependence, sedation, and withdrawal. Lithium is used for bipolar disorder or selected augmentation strategies, not routine initial monotherapy for unipolar depression. Antipsychotic monotherapy is not indicated without psychosis and carries substantial adverse effects. Follow-up should assess adherence, adverse effects, symptom change, functional recovery, emergent mania, and suicide risk, with treatment adjustment if response is inadequate.

Reference: American College of Physicians. ACP Recommends Cognitive Behavioral Therapy or a Second-Generation Antidepressant for Major Depressive Disorder. https://www.acponline.org/acp-newsroom/american-college-of-physicians-recommends-cognitive-behavioral-therapy-or-second-generation