A 28-year-old woman with a first episode of major depressive disorder, no suicidality, and no psychotic features is started on sertraline. After four weeks she reports mild improvement in sleep but persistent depressed mood and anhedonia. What is the most appropriate next step?
- A Continue sertraline at the current dose for a total of 8 weeks before reassessing response ✓
- B Switch immediately to a tricyclic antidepressant
- C Add lithium augmentation
- D Initiate electroconvulsive therapy
Correct answer: A. Continue sertraline at the current dose for a total of 8 weeks before reassessing response
Explanation
Antidepressant trials for major depressive disorder require an adequate duration of at least 6–8 weeks at therapeutic dose before a response determination is made. Early partial improvement in vegetative symptoms such as sleep is common and does not indicate treatment failure. Switching or augmenting before completing an adequate trial is premature in a first episode with partial benefit. ECT and lithium augmentation are reserved for treatment-resistant or severe cases.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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