Rosh Psychiatry Board Practice Exam

Which therapy is most appropriate for a 38-year-old man experiencing excessive worry and distress for six months?

1. Amitriptyline, at a starting dose equal to that used in major depressive disorder

2. Amitriptyline, at a starting dose half that used in major depressive disorder

3. Sertraline, at a starting dose equal to that used in major depressive disorder

4. Sertraline, at a starting dose half that used in major depressive disorder

The correct answer is: Sertraline, at a starting dose half that used in major depressive disorder

The selection of therapy for a 38-year-old man experiencing excessive worry and distress over a six-month period suggests the presence of generalized anxiety disorder (GAD). In such cases, selective serotonin reuptake inhibitors (SSRIs) like sertraline are often considered a first-line treatment due to their efficacy in managing anxiety symptoms. Starting with sertraline at a dose that is half the typical dose used for major depressive disorder is appropriate for several reasons. First, patients with anxiety disorders can often be more sensitive to the side effects of medication, and initiating treatment at a lower dose allows for a better tolerance profile. This gradual approach in dosing helps minimize potential side effects, making it more likely that the patient will remain compliant with the treatment regimen. Moreover, evidence supports the effectiveness of sertraline in treating anxiety while also favoring a cautious initiation of therapy — starting at a lower dose allows for monitoring of response and makes it easier to adjust the dose if necessary to achieve optimal relief of symptoms. In contrast, the other options involving amitriptyline are less favorable for anxiety management. While amitriptyline is an antidepressant that can be effective for certain conditions, it is typically not the first choice for GAD due to its