How I Treat: Next Steps After Treatment Failure in a Patient With MDD

W. Clay Jackson, MD, DipTh | University of Tennessee, Memphis Tennessee

Your patient is a 42-year-old software developer who first reported a depressed mood a year and a half ago. She was treated for 3 months with escitalopram but did not notice substantive improvement, so she stopped adhearing to the regimen. Subsequently, her depression worsened about 6 weeks ago when she presented to your office. Her Patient Health Questionnaire-9 (PHQ-9) score was 16, indicating moderately severe disease. Her Rapid Mood Screener result was negative, indicating a low risk for bipolar disorder. She had hypercholesterolemia, which was controlled by her diet, with mild obesity (BMI 32 kg/m2).

She was unwilling to begin cognitive behavioral therapy (CBT) but was open to another trial of medication. You prescribed sertraline at a dose of 50mg/d. She returned 3 weeks later and reported that she did not feel much better. Her PHQ-9 score is 15. She had been adherent to therapy, but reported she had some nausea.