Step 2

Psychiatry 2

A 52-year-old man undergoes follow-up for persistent major depressive disorder. He is currently being treated with venlafaxine (Effexor); he previously took fluoxetine (Prozac) titrated to the maximum dosage before it was tapered off owing to minimal response and sexual side effects. He also takes aripiprazole (Abilify) and receives psychotherapy. He reports no improvement in his symptoms, which do not include mania or hypomania. He has not had suicidal ideation. He has no other medical conditions and takes no other medications.

On exam, vital signs are normal. He appears sad with a blunted affect. PHQ-9 (Patient Health Questionnaire-9) for depression screening & severity monitoring is 17 which is consistent with moderately severe depression, which is slightly worse from his previous score.

Which of the following is the most appropriate treatment?

  • A) Add intranasal esketamine (Spravato)
  • B) Add valproic acid
  • C) Add lithium
  • D) Discontinue aripiprazole and initiate risperidone
  • E) Discontinue venlafaxine and initiate paroxetine (Paxil)


Dr. Raj Dasgupta


Dr. Raj Dasgupta

Last updated

Sep 24, 2022

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