Feedback for A 25-year-old presents to your practice with a depressed mood that has worsened during the past few weeks. The patient finds it difficult to get out of bed in the morning. When not sleeping, the patient is eating. Weight has increased by 4.5 kg (10 lb) in the past month. They are worried about their job and do not feel that they are “pulling [their] weight,” even though they recently received a glowing evaluation. They have passive thoughts of harming themselves but no definite plan. Medical history includes anxiety, gastroesophageal reflux disease, and hypothyroidism (thyroid-stimulating hormone [TSH] within normal limits). Current medications include Levothyroxine 100 mcg daily, Lansoprazole 30 mg every morning, and Alprazolam 0.5 mg three times daily for anxiety. Which medication would best treat the current symptoms?

Patient-specific considerations:

Already has generalised anxiety → sertraline generally preferred over fluoxetine.
Already on regular benzodiazepine, suggesting anxiety is significant. Fluoxetine might worsen anxiety initially.
Weight gain is present, but neither sertraline nor fluoxetine is strongly obesogenic; paroxetine would be worse.
Passive suicidal ideation: SSRIs are appropriate, but fluoxetine’s long half-life is not a particular advantage here.

Conclusion:
Sertraline would be the preferred first-line SSRI in this patient. It covers both depression and anxiety, has fewer interactions, and is usually well tolerated.

Location: 4.2 Pharmacokinetics Quiz