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Please read and respond to at least two of your peers’ initial postings. You may want to consider the following questions in your responses to your peers:
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· How are they similar or how are they different?
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Reply from Aebin Newsom
Initial Post
Based upon this patient’s presentation, the DSM-5TR diagnosis that mostly aligns with the described ailments is major depressive disorder. The patient complaints of a persistent depressed mood, crying spells, insomnia, anhedonia, fatigue, decreased concentration, significant weight loss, and significant recurrent feelings of worry/anxiety signify this. This patient has been experiencing these symptoms for three weeks, which meets the 2-week criteria for major depressive disorder. These symptoms impair this patient’s daily functioning as evidenced by the patient stating that she feels she is ‘losing’ her children and episodes in which patient missed work due to fatigue and inability to concentrate.
In the treatment of major depressive disorder, many pharmacological classes of medications can be used. SSRIs, SNRIs, NDRIs, NaSSa, TCAs, MAOIs, and serotonin modulators are all commonly used to treat major depressive disorder (Bains & Abdijadid, 2025). Generally speaking, since escitalopram is one of the most effective SSRIs and is well-tolerated in terms of side effects, I would be more opted to start the patient on it. However, given the patient’s symptoms of insomnia, weight loss, and decrease appetite I might be more opted to start the patient on mirtazapine. Due to its alpha-2 antagonistic activities and antihistaminergic properties, mirtazapine has been shown to stimulate appetite and induce a sense of sedation (Hassanein et al., 2024) which directly counteracts this patient’s presenting symptoms. Additionally, this patient is a young 24-year-old with no history of hypertension or cardiac disease, so I am less concerned with the risk of developing hypertension in using mirtazapine. Moreover, I would prescribe the patient on 15mg of mirtazapine to be taken daily at bedtime, as this is the typical starting dose (Jilani et al., 2024). I would also refer the patient out for cognitive behavioral therapy with a psychotherapist.
References
Bains, N., & Abdijadid, S. (2025). Major depressive disorder. In
StatPearls.
Hassanein, E. H. M., Althagafy, H. S., Baraka, M. A., Abd-Alhameed, E. K., & Ibrahim, I. M. (2024). Pharmacological update of mirtazapine: A narrative literature review.
Naunyn-Schmiedeberg’s Archives of Pharmacology, 397(5), 2603–2619.
Jilani, T. N., Gibbons, J. R., Faizy, R. M., et al. (2025). Mirtazapine. In
StatPearls.
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Reply from Ralph Annam
Most Likely Diagnosis
The patient satisfies DSM-5-TR criteria for Major Depressive Disorder (MDD), exhibiting persistent low mood, anhedonia, insomnia, impaired concentration, appetite reduction, weight loss, and functional impairment for over two weeks (APA, 2022).
Types of Medications
SSRIs (first-line: sertraline, fluoxetine, and escitalopram)
SNRIs include venlafaxine and duloxetine.
Antidepressants that are not typical (bupropion, mirtazapine)
TCAs and MAOIs are second-line drugs because they have side effects (Gartlehner et al., 2021).
Recommended Drug and Dose
The first line of treatment is to take 50 mg of sertraline every day. SSRIs are considered first-line treatment because they are effective, safe, and well-tolerated by most people (Qaseem et al., 2023). Sertraline is particularly beneficial for individuals who experience fatigue and struggle with concentration (Papakostas et al., 2020). The 50 mg starting dose strikes a balance between therapeutic effects and minimizing side effects, with titration as needed.
References
American Psychiatric Association. (2022).
Diagnostic and statistical manual of mental disorders (5th ed., text rev.). APA.
Gartlehner, G., Wagner, G., Patel, S., & Remick, R. A. (2021). Efficacy and safety of antidepressants for major depressive disorder in adults.
Cochrane Database of Systematic Reviews, 2021(9), CD013778.
Papakostas, G. I., Stahl, S. M., Krishen, A., Seifert, C. A., Tucker, V. L., & Goodale, E. P. (2020). Efficacy of sertraline in major depressive disorder with atypical features.
Journal of Affective Disorders, 266, 749–755.
Qaseem, A., Barry, M. J., Kansagara, D., & Clinical Guidelines Committee of the American College of Physicians. (2023). Nonpharmacologic and pharmacologic treatments of adults with MDD.
Annals of Internal Medicine, 176(1), 51–65.
