**Question:** A female patient presented with depressed mood, loss of appetite and no interest in surroundings. There is associated insomnia. The onset of depression was preceded by a history of business loss and soon after it she developed the following symptoms for the past one year. True statement regarding management of this patient is?

A. Antidepressants
B. Psychotherapy
C. Both A and B
D. None of the above

**Core Concept:** Depression is a mental health disorder characterized by persistent feelings of sadness, loss of interest, and changes in appetite, sleep, and energy levels. In addition to mood symptoms, the patient also exhibits anorexia, insomnia, and a history of significant life event (business loss). This clinical picture aligns with Major Depressive Disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and International Classification of Diseases (ICD-10) criteria.

**Why the Correct Answer is Right:**

C. Both A and B

In this scenario, the patient exhibits symptoms consistent with Major Depressive Disorder (MDD) and is likely to benefit from a combination of pharmacological intervention and psychological treatment. Antidepressants (A), such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), can help alleviate the symptoms of depression by increasing neurotransmitter levels in the brain, specifically serotonin and norepinephrine. These medications are often used as a first-line treatment for MDD.

Psychotherapy (B) plays a significant role in managing the patient's condition as well. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are evidence-based treatments targeting the underlying mood disorder and addressing social support and coping mechanisms.

**Why Each Wrong Option is Incorrect:**

A. Antidepressants alone (Option A) might not address the patient's psychological and social factors contributing to their depression, leading to suboptimal outcomes without psychotherapy.

B. Psychotherapy (Option B) alone might not address the physical symptoms of anorexia and insomnia, which are part of the patient's presentation.

D. Incomplete treatment options (Options A and B) might not address the patient's needs comprehensively, leading to suboptimal management of MDD symptoms.

**Clinical Pearl:**

In cases of severe depression with prominent physical symptoms, consider a comprehensive treatment approach combining pharmacological intervention (antidepressants) and psychological treatment (psychotherapy) to address the patient's mood disorder and its physical manifestations, as well as underlying psychological factors and social support. This holistic approach improves effectiveness in managing MDD symptoms and overall patient well-being.