A 34-Year-Old Woman Comes to the Office for a Routine

A 34-year-old woman comes to the office for a routine checkup.  She initially says, "Everything's fine."  Later she says, "I have been in a funk since being passed over for a promotion at work last month.  I guess it's normal to be disappointed, but I am down on myself and feel totally worthless.  It's really hard to be motivated now and some days I wish I could stay in bed all day."  The patient describes difficulty concentrating on her work assignments and explains that she is tired at work because she sleeps poorly at night.  She has lost 1.8 kg (4 lb) without dieting and says, "I used to enjoy cooking, but now I just snack or eat prepared foods."  The patient lives with her husband and describes him as supportive.  She does not use tobacco or illicit drugs.  She drinks a glass of wine 4-5 times a week.  The patient has no history of psychiatric illness or treatment.  Her mother and sister suffered from depression and were treated successfully with antidepressants.  On mental status examination, the patient has depressed mood and sad affect but no suicidal ideation.  Physical examination and routine laboratory testing are unremarkable.  A diagnosis of major depressive disorder is made and treatment options are discussed.  The patient is open to psychotherapy or taking antidepressants but would like to avoid medications that may cause weight gain.  She asks the physician which treatment is most effective.  Which of the following is the most appropriate response to this patient?

A) Both are effective, but psychotherapy would be preferred in your case because all antidepressants cause weight gain.
B) Both are helpful, but antidepressants are generally superior to psychotherapy.
C) Psychotherapy is more effective than antidepressants when the depression is triggered by an event.
D) Some classes of antidepressants are more effective than others.
E) The combination of antidepressants and psychotherapy is more effective than either treatment alone.