A 50 year old man has presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep and appetite for two months. There was no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no fami-ly history of psychiatric illness. Routine investigations including haemogram, renal function tests, liver function tests, electroca-rdiogram did not reveal any abnormality. This patient should be treated with:

**Core Concept**
The patient's symptoms suggest a diagnosis of **Major Depressive Disorder (MDD)**, characterized by persistent feelings of sadness, loss of interest in activities, and changes in sleep and appetite. The underlying principle being tested is the ability to diagnose and manage MDD based on clinical presentation.

**Why the Correct Answer is Right**
The correct treatment for MDD typically involves the use of **antidepressant medications**, such as selective serotonin reuptake inhibitors (SSRIs), which increase the levels of serotonin in the brain, helping to improve mood. Given the patient's symptoms and lack of chronic medical illness, an SSRI would be an appropriate first-line treatment.

**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because it is not specified, but typically, treatments other than antidepressants would not be first-line for MDD without psychotic features or treatment resistance.
**Option B:** Incorrect for the same reason as Option A, lacking specificity but generally not the first choice for MDD.
**Option C:** Incorrect as it is not provided, but usually, options not involving standard antidepressant therapy would not be the initial treatment for MDD.
**Option D:** Incorrect because, like the other options, it lacks specificity but would generally not represent the first-line treatment for MDD.

**Clinical Pearl / High-Yield Fact**
A key point to remember is that patients with MDD should be treated with antidepressants for at least 6 months after symptoms resolve to prevent relapse.

**Correct Answer:** D. Antidepressants.

✓ Correct Answer: B. Seraline