Which is the most appropriate treatment option for this patient?

Paroxetine

Answer and Critique (Correct Answer = A) Key Points * All the selective serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitors are effective for depression and generalized anxiety disorder and have Food and Drug Administration approval for these indications. * Depressive symptoms often respond more quickly to treatment than do anxiety symptoms, and it is not uncommon for anxiety to be unmasked during the first few weeks of antidepressant treatment. This patient has major depression and generalized anxiety disorder and should receive paroxetine. All the selective serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitors are effective for depression and generalized anxiety disorder and have Food and Drug Administration (FDA) approval for these indications. Bupropion is a proven antidepressant and clonazepam is a proven anxiolytic, but neither is FDA approved for treating depression and anxiety. The atypical antipsychotic agents, such as risperidone, olanzapine, and quetiapine, are sometimes added to antidepressant therapy to augment response in patients with treatment-resistant major depressive disorder but are not indicated as monotherapy for major depression and dysthymia or generalized anxiety disorder. Patients with depression commonly have some symptoms of anxiety also, and approximately one third meet the criteria for a concomitant anxiety disorder. Depressive symptoms often respond more quickly to treatment than do anxiety symptoms, and it is not uncommon for anxiety to be unmasked during the first few weeks of antidepressant treatment. Bibliography 1. Kroenke K, West SL, Swindle R, Gilsenan A, Eckert GJ, Dolor R, et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA. 2001;286:2947-55. [PMID: 11743835] [PubMed]