Which treatment combination is considered first-line for major depressive disorder?

• A. SNRI alone with no psychotherapy.
• B. TCA with psychotherapy.
• C. MAOI with psychotherapy.
• D. SSRI such as sertraline or escitalopram with psychotherapy.

Answer: (D)

The main idea is that treating major depressive disorder effectively often involves both a modern antidepressant and psychotherapy. SSRIs like sertraline or escitalopram are preferred as first-line pharmacotherapy because they reduce depressive symptoms with a favorable safety and tolerability profile. Pairing an SSRI with psychotherapy—such as cognitive-behavioral therapy—addresses both biological symptoms and maladaptive thinking patterns, and this combination yields better remission and functional outcomes than either approach alone.

Other options rely on drugs with more side effects or safety concerns (like TCAs or MAOIs) or propose pharmacotherapy without psychotherapy, which is generally less effective for moderate to severe depression. So using an SSRI together with psychotherapy is the best-supported first-line approach.