A 23 year old man comes to psychiatry outpatient due to symptoms of occasional sleep disturbances and ‘feeling low’. The symptoms staed 2 months back after he found that his girlfriend was cheating on him and was in a relationship with her boss. The patient immediately broke up with her. However since than he has been feeling sad, although he is able to feel much better the he hits the gym. The patient fuher repos that he doesn’t like meeting people much and doesn’t feel like going to work, although he hasn’t taken any leaves and is able to fulfil all her professional responsibilities. What is the best next step in the treatment of this patient?

**Core Concept**
The patient is experiencing symptoms of depression, including sleep disturbances, low mood, loss of interest in activities, and social withdrawal, following a significant life event. This scenario illustrates a common presentation of major depressive disorder (MDD) in the context of post-traumatic stress.

**Why the Correct Answer is Right**
The patient's symptoms and history suggest a diagnosis of major depressive disorder (MDD). The best next step in treatment is to initiate a selective serotonin reuptake inhibitor (SSRI), such as sertraline or fluoxetine, which is a first-line treatment for MDD. SSRIs work by increasing the levels of serotonin in the synaptic cleft, thereby improving mood and reducing symptoms of depression. The patient's ability to feel better after exercise suggests that physical activity may have a positive effect on his mood, but this is not a substitute for pharmacological treatment. Given the patient's ability to fulfill his professional responsibilities, a trial of medication is a reasonable next step.

**Why Each Wrong Option is Incorrect**
**Option A:** Referral to a therapist or counselor may be helpful in the long term, but it is not the best next step in treatment, as the patient is already experiencing significant distress and impairment.
**Option B:** A trial of a benzodiazepine may be helpful in the short term for anxiety symptoms, but it is not a first-line treatment for depression and may have adverse effects with long-term use.
**Option C:** A trial of a stimulant medication may be helpful for patients with attention deficit hyperactivity disorder (ADHD), but it is not indicated for the treatment of depression.

**Clinical Pearl / High-Yield Fact**
It's essential to note that patients with depression may experience a delay in seeking treatment, and it's crucial to assess for suicidal ideation and risk in patients with depression.

**Correct Answer: C. A trial of a stimulant medication may be helpful for patients with attention deficit hyperactivity disorder (ADHD), but it is not indicated for the treatment of depression.

✓ Correct Answer: B. Psychotherapy