A 72-year-old woman with type 2 diabetes, hypertension, and CKD stage 3a (eGFR 48) presents with a 6-month history of low mood, anhedonia, poor sleep,...

Question

A 72-year-old woman with type 2 diabetes, hypertension, and CKD stage 3a (eGFR 48) presents with a 6-month history of low mood, anhedonia, poor sleep, and poor concentration. She has been on Citalopram 20 mg for 3 months prescribed by her previous GP with no improvement. Her PHQ-9 score is 16 (moderately severe). What is the MOST appropriate next step?

Accepted Answer

Refer for cognitive behavioural therapy (CBT) alongside medication review

Answer

Increase Citalopram to 40 mg daily

Answer

Switch to Sertraline 50 mg daily

Answer

Add Mirtazapine 15 mg at night as augmentation

Answer

Stop all antidepressants as they are not working

uk-dgm MCQ (SBA): Treatment-Resistant Depression in Older People