What are common first-line pharmacologic treatments for anxiety and depressive disorders?

• A. SSRI s and SNRI s; sometimes bupropion or mirtazapine; augmentation with antipsychotics in resistant depression; psychotherapy often paired
• B. Benzodiazepines as primary treatment
• C. Antidepressants are not effective
• D. Ketamine as first-line for all mood disorders

Answer: (A)

The main idea here is that first-line pharmacologic treatment for anxiety and depressive disorders centers on antidepressants that have broad efficacy and tolerability. SSRIs and SNRIs are the usual starting point because they reliably reduce a wide range of anxiety and depressive symptoms with a relatively favorable safety profile. When SSRIs or SNRIs aren’t suitable or well tolerated, other antidepressants like bupropion or mirtazapine can be appropriate alternatives. For cases that don’t respond adequately to standard antidepressants, augmentation with a second-generation antipsychotic is a common approach to boost response in resistant depression. Psychotherapy is often paired with medication to improve outcomes, reinforcing the treatment effect.

Benzodiazepines are generally not used as the primary long-term treatment due to risks of dependence and withdrawal, and ketamine is typically reserved for treatment-resistant or urgent cases rather than as a universal first-line option. Antidepressants do have proven effectiveness for these disorders, so saying they’re not effective wouldn’t fit with clinical practice.