A 38-year-old woman was referred to a psychiatrist after tellingher primary care physician that she had difficulty sleeping(awakening at 4 AM frequently for the past few months) anda lack of appetite causing a weight loss of over 20 lb. She alsosaid she no longer enjoyed going out with her friends or doingvolunteer service for underprivileged children. What type ofdrug is her doctor most likely to suggest as an initial step in hertherapy?A. A serotonergic receptor antagonistB. A selective serotonin reuptake inhibitorC. An inhibitor of monoamine oxidaseD. An amphetamine-like drugE. A drug that causes an increase in both serotonin anddopamine levels

To determine the most likely type of drug the psychiatrist would suggest for the 38-year-old woman, let's analyze her symptoms and the options provided:

1. Symptoms:
   • Difficulty sleeping (frequent awakening at 4 AM)
   • Lack of appetite leading to significant weight loss (over 20 lb)
   • Loss of interest in social activities and volunteer work

These symptoms are indicative of major depressive disorder (MDD), which often includes early morning awakening, significant weight loss, and anhedonia (loss of interest in previously enjoyable activities).

2. Drug Options:
   • A. A serotonergic receptor antagonist: These drugs block serotonin receptors but are not typically first-line treatments for depression.
   • B. A selective serotonin reuptake inhibitor (SSRI): These drugs increase serotonin levels in the brain by inhibiting its reuptake. SSRIs are commonly used as first-line treatments for depression due to their efficacy and relatively favorable side effect profile.
   • C. An inhibitor of monoamine oxidase (MAOI): These drugs increase levels of various neurotransmitters by inhibiting the enzyme monoamine oxidase. While effective, they are generally not first-line treatments due to dietary restrictions and potential side effects.
   • D. An amphetamine-like drug: These are typically used for attention deficit hyperactivity disorder (ADHD) and narcolepsy, not for depression.
   • E. A drug that causes an increase in both serotonin and dopamine levels: These drugs can be effective but are not usually the first choice for initial treatment of depression.

Given the symptoms and the typical treatment protocols for major depressive disorder, the most likely drug the psychiatrist would suggest as an initial step in her therapy is:

B. A selective serotonin reuptake inhibitor (SSRI)

SSRIs are commonly prescribed for depression and are effective in treating the symptoms described.