A 34-year-old woman has had low mood, poor sleep, anhedonia and reduced appetite for 8 weeks. Her PHQ-9 score is 17 and she has no suicidal ideas. She prefers medication. What is the most appropriate first step?

Answer and explanation

Correct answer: B. Start an SSRI such as sertraline and review her within 2 weeks

  1. Step 1: This is moderate to severe depression.
  2. Step 2: NICE NG222 offers an antidepressant, usually an SSRI, with a first review usually within 2 weeks (within 1 week if aged 18 to 25 or at particular risk of suicide).
Answer
Start an SSRI such as sertraline and review her within 2 weeks.
Why not the others: Prescribe diazepam 5 mg three times daily for the next three months: Benzodiazepines do not treat depression and cause dependence. Start amitriptyline 150 mg daily as the first-line antidepressant choice: Tricyclics are more toxic in overdose and are not first-line. Advise watchful waiting for six months before offering any treatment: Waiting this long is not appropriate for moderate to severe symptoms.

Practise more Mood, anxiety and self-harm.

Free questions with an explanation for every one, and full timed PLAB 1 (GMC, international medical graduates) mock tests.

All Mood, anxiety and self-harm questionsTake a mock test

More Mood, anxiety and self-harm questions