Review Question - QID 105781

This patient has symptoms consistent with major depressive disorder. Selective serotonin reuptake inhibitors (SSRI's), such as paroxetine, are first line treatment for major depressive disorder.

Major depressive disorder is a self-limited disorder, with each episode usually lasting 6-12 months and characterized by at least 5 of the following 9 symptoms for 2 or more weeks. These symptoms include:

1. Sleep disturbance
2. Anhedonia
3. Guilt
4. Loss of energy
5. Loss of concentration
6. Appetite/weight changes
7. Psychomotor retardation
8. Suicidal ideations
9. Depressed mood

Symptoms must include depressed mood or anhedonia. Notably, while the episodes last 6-12 months, major depressive disorder tends to be a chronic condition that patients deal with for many years especially if it is not diagnosed and treated successfully.

Adams et al. discuss pharmacologic management of adults with depression. Major depression is a common and treatable disease. Medication choices should be made based on patient characteristics, safety, and anticipated side effects. The risk of suicide is always a concern in depression. This risk is not necessarily reduced by the use of antidepressants. In fact, some persons may have an increase in suicidal thoughts with antidepressant treatment.

Ables et al. discuss new agents in the treatment of major depressive disorder. Selective serotonin reuptake inhibitors remain the drugs of choice and also have indications in the treatment of obsessive-compulsive disorder, panic disorder, and social phobia. Newer indications for these drugs include post-traumatic stress disorder, premenstrual dysphoric disorder, and generalized anxiety disorder.

Illustration A shows the mechanism of action of SSRIs at the synaptic cleft.

Incorrect Answers:
Answers 1 and 2: Olanzapine and aripiprazole are atypical antipsychotics. While they can be used for schizophrenia, they are not a first line therapy for major depressive disorder without psychotic features.
Answer 3: Lithium is a first line therapy for bipolar disorder but not for major depressive disorder.
Answer 4: Lorazepam is a short/medium acting benzodiazepine which can be used as an anxiolytic but is not a first line treatment for major depressive disorder.