Rosh Psychiatry Board Practice Exam

What is the best initial treatment for a patient with three years of depression and no improvement from support group therapy?

1. Electroconvulsive therapy

2. Pharmacotherapy alone

3. Pharmacotherapy and psychotherapy

4. Psychotherapy alone

The correct answer is: Pharmacotherapy and psychotherapy

For a patient who has experienced three years of depression with no improvement from support group therapy, an integrated approach combining pharmacotherapy and psychotherapy is often considered the most effective initial treatment strategy. This combination addresses both the biological and psychosocial aspects of depression. Pharmacotherapy, typically involving antidepressant medications, can help alleviate the symptoms of depression by correcting chemical imbalances in the brain, while psychotherapy provides a supportive environment for the patient to explore underlying issues, develop coping strategies, and improve overall functioning. Research has shown that utilizing both treatments concurrently can have additive effects and increase the likelihood of achieving remission compared to using either treatment alone. While other treatment options, such as electroconvulsive therapy, may be appropriate in cases of severe or treatment-resistant depression, they are generally not the first line of treatment for a patient who has not previously tried pharmacotherapy or therapy in combination. Moreover, psychotherapy alone may not be sufficient given the chronic nature of the patient's depression and the reported lack of improvement from support groups, indicating the need for a more robust intervention.