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Major depressive disorder medication follow-up — USMLE Step 3 MCQ

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HardPsychiatryMajor depressive disorder medication follow-upUSMLE Step 3

Four weeks after starting sertraline for major depressive disorder, a patient has improving nausea, no suicidality and PHQ-9 improvement from 19 to 11. They are adherent and have no history of mania. What is the best next step?

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Correct answer: D — Continue the current dose and reassess symptom trajectory before changing therapy

The best answer is “Continue the current dose and reassess symptom trajectory before changing therapy”. At four weeks, partial PHQ-9 improvement and resolving nausea support continuation of the current antidepressant while allowing an adequate trial. Electroconvulsive therapy, immediate switching, lithium augmentation, or scheduled alprazolam are not indicated in this stable early partial-response scenario.

Reference: American College of Physicians, Major Depressive Disorder Guideline: https://www.acponline.org/clinical-information/guidelines