USMLE PRACTICE QUESTION OF THE WEEK

Question for October 31, 2025

A 20-year-old college student is brought by her roommate because of 4 weeks of low mood, anhedonia, insomnia, and poor concentration. She is missing classes and meals, has withdrawn from friends, and describes persistent feelings of worthlessness. She denies suicidal thoughts, intent, or prior self-harm. She has no medical problems and takes no medications. There is no family history of bipolar disorder. Vitals are normal. Physical exam is unremarkable. PHQ‑9 score is 17. She is willing to start treatment and to return for close follow-up but declines hospitalization, stating she feels safe at home and on campus.

Which of the following is the most appropriate next step in management?

Correct Answer:

E. SSRI therapy and follow-up

Correct Answer Explanation:

She meets criteria for major depressive disorder without suicidality or psychosis. First-line treatment includes an SSRI (e.g., sertraline, escitalopram) and/or structured psychotherapy; either alone is acceptable, and many patients benefit from combining them. Inpatient admission is unnecessary unless there are safety concerns. Nonclinical counseling or referral without active treatment delays care.

Further Insight:

  • Screen for bipolar disorder before antidepressants.
  • Arrange early follow-up (1-2 weeks) to assess response and safety.