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Major depressive disorder — ABIM Board MCQ

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HardPsychiatry relevant to IMMajor depressive disorderABIM Board

A 44-year-old woman with moderate major depression begins escitalopram. At eight weeks she has taken 20 mg daily consistently, adverse effects are tolerable, and PHQ-9 improves from 19 to 14, but occupational impairment remains substantial. She prefers medication over psychotherapy. What is the most appropriate next strategy?

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Correct answer: E — Switch antidepressants or add a pharmacologic augmentation agent

The best answer is “Switch antidepressants or add a pharmacologic augmentation agent”. A partial but inadequate response after an adequate dose and duration warrants a structured next step: switching to another second-generation antidepressant or augmentation chosen according to symptoms, comorbidity, adverse effects, and preference. Simply waiting prolongs impairment; abrupt cessation risks withdrawal, and benzodiazepines do not treat core depression.

Reference: American College of Physicians Guideline: Treatment of Major Depressive Disorder: https://pubmed.ncbi.nlm.nih.gov/38261342/