For a patient with major depressive disorder in primary care, what is the first-line pharmacologic treatment?

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Multiple Choice

For a patient with major depressive disorder in primary care, what is the first-line pharmacologic treatment?

Major depressive disorder in primary care is best started with an antidepressant that works well, is well tolerated, and has manageable safety concerns, paired with psychotherapy. An SSRI, such as sertraline, fits this role well because it reliably reduces depressive symptoms and has a favorable safety and side effect profile compared with older drugs. It has fewer dangerous interactions and a lower risk of life-threatening overdose than tricyclic antidepressants, and it does not carry the dietary restrictions and significant interaction risks associated with MAO inhibitors. Benzodiazepines are not antidepressants and don’t treat the underlying mood disorder; they’re mainly for short-term anxiety or agitation and can lead to dependence, so they’re not first-line for major depression. Adding psychotherapy, such as cognitive-behavioral therapy or interpersonal therapy, improves outcomes and helps reduce relapse, especially in moderate to severe cases or when adherence to medication is a concern. Start with an SSRI and arrange psychotherapy, monitor response over several weeks, and adjust as needed.

Major depressive disorder in primary care is best started with an antidepressant that works well, is well tolerated, and has manageable safety concerns, paired with psychotherapy. An SSRI, such as sertraline, fits this role well because it reliably reduces depressive symptoms and has a favorable safety and side effect profile compared with older drugs. It has fewer dangerous interactions and a lower risk of life-threatening overdose than tricyclic antidepressants, and it does not carry the dietary restrictions and significant interaction risks associated with MAO inhibitors. Benzodiazepines are not antidepressants and don’t treat the underlying mood disorder; they’re mainly for short-term anxiety or agitation and can lead to dependence, so they’re not first-line for major depression.

Adding psychotherapy, such as cognitive-behavioral therapy or interpersonal therapy, improves outcomes and helps reduce relapse, especially in moderate to severe cases or when adherence to medication is a concern. Start with an SSRI and arrange psychotherapy, monitor response over several weeks, and adjust as needed.

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