AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 40-year-old female with a history of generalized anxiety disorder (GAD) has been taking sertraline 50 mg daily for 6 weeks. She reports some improvement in her anxiety but still experiences significant worry and muscle tension. Which of the following is the most appropriate next step in her treatment plan?
- ARefer her for cognitive behavioral therapy (CBT) only.
- BIncrease the sertraline dose to 75 mg daily.
- CAdd a benzodiazepine to her current regimen.
- DSwitch to a different antidepressant class, such as a tricyclic antidepressant (TCA).
Show answer & explanationAnswer & explanation
Correct answer: B. Increase the sertraline dose to 75 mg daily.
After 6 weeks on an initial therapeutic dose of an SSRI for GAD, if there is partial response but not full remission, the next step is typically to titrate the dose upwards. Sertraline has a maximum dose of 200 mg daily, so 75 mg is a reasonable increase.
Why the other options are wrong
- A. CBT is a valuable adjunct but should be considered alongside, not instead of, optimizing pharmacotherapy for a partial responder.
- C. Benzodiazepines are generally reserved for short-term use or acute anxiety due to dependence potential and side effects, not as a primary augmentation strategy after partial SSRI response.
- D. Switching classes is usually considered after failure to respond to an adequate trial of at least two different SSRIs/SNRIs.
Antidepressant Partial Response Management
For partial response to an antidepressant after an adequate trial (typically 4-8 weeks), the initial strategy is usually to increase the dose of the current medication.
- Adequate trial duration is crucial before dose adjustment or switching.
- Dose escalation is preferred over immediate switching for partial response.
- Maximum therapeutic doses should be considered before changing agents.
Memory trick: If the SSRI's not quite right, 'UP' the dose to make things bright!