Behavioral Science & Ethics USMLE Step 1 Practice Question
A 40-year-old man with moderate depression (PHQ-9 score 16) is prescribed sertraline 50 mg daily. After one week, he reports worsening mood and anxiety, with HR 92 bpm and mild insomnia. He demands immediate discontinuation, convinced the medication is harmful. He denies suicidal ideation and has no prior medication trials. His psychiatrist notes this represents early treatment response variability rather than true medication failure. Which counseling approach is most appropriate?
Answer choices
- ARecommend psychotherapy alone and avoid medication
- BDiscontinue the medication immediately to prevent harm
- CAdd an antipsychotic to counteract the side effects
- DSwitch to a different SSRI at a higher dose
- EExplain that initial worsening is common, continue the medication, and follow up closelyCorrect answer
- FIncrease sertraline to 100 mg daily to achieve faster therapeutic effect and override the initial adverse effects
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