**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. Psychotherapy as the primary treatment option
B. Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs)
C. Electroconvulsive therapy (ECT) for severe depression
D. Lifestyle modifications as the first-line intervention

**Correct Answer:** B. Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs)

**Core Concept:**

The patient is presenting with a combination of symptoms that are characteristic of major depressive disorder (MDD) or major depressive episode (MDE) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) or International Classification of Diseases (ICD-11). MDD and MDE are mood disorders characterized by a significant reduction in mood, loss of interest or pleasure in activities, and changes in appetite and sleep patterns. The presence of insomnia, which is a common symptom of depression, supports the clinical diagnosis.

**Why the Correct Answer is Right:**

The correct answer is pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) because the patient exhibits severe symptoms of depression, which require immediate and effective treatment to prevent worsening of the condition and potential complications. SSRIs are a class of antidepressants that work by increasing the availability of serotonin, a neurotransmitter involved in mood regulation. They are generally well-tolerated and effective with fewer side effects compared to other classes of antidepressants. In this case, the patient's history of business loss and subsequent depression suggests a strong psychological impact, making SSRIs a suitable choice.

**Why Each Wrong Option is Incorrect:**

A. Psychotherapy: While psychotherapy can be beneficial in addressing the underlying psychological stressors and coping strategies, the patient's severe depressive symptoms warrant immediate pharmacological intervention with SSRIs.

C. Electroconvulsive therapy (ECT): ECT is a last resort treatment for treatment-resistant depression or severe cases. In this case, SSRIs would be a more appropriate choice.

D. Lifestyle modifications: While lifestyle modifications can support the patient's mental health and well-being, they are not sufficient for treating the severe depressive symptoms presented by the patient. Pharmacological intervention with SSRIs is necessary.

**Clinical Pearl:**

One important aspect to consider when treating a depressed patient is the role of psychotherapy, particularly cognitive-behavioral therapy (CBT). This form of psychotherapy can be beneficial in addressing the patient's stressors, coping strategies, and improving their overall mental health. However, severe depressive symptoms require immediate pharmacological interventions, making SSRIs a suitable choice in this case.

The patient's history of business loss and subsequent depression suggests a strong psychological impact, which is best managed with medication, specifically SSRIs. These drugs enhance serotonin levels, which are