AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 30-year-old female presents with symptoms of generalized anxiety disorder (GAD). She has been taking sertraline 50 mg daily for 6 weeks and reports some improvement, but still experiences significant anxiety and interferes with her daily life. She denies side effects. What is the most appropriate next step in her treatment plan?
- ARefer for cognitive behavioral therapy (CBT) only.
- BAdd buspirone 5 mg BID.
- CSwitch to venlafaxine XR 75 mg daily.
- DIncrease sertraline to 75 mg daily.
Show answer & explanationAnswer & explanation
Correct answer: D. Increase sertraline to 75 mg daily.
For GAD, if a patient has partial response to an SSRI after an adequate trial (typically 4-6 weeks) and tolerates the medication, the dose should be increased to optimize treatment before switching to another agent or adding another medication.
Why the other options are wrong
- A. CBT is an important adjunct, but discontinuing or not optimizing pharmacotherapy while symptoms are significant is not the best approach for partial responders.
- B. Adding buspirone is an option for augmentation, but typically considered after optimizing the SSRI dose.
- C. Switching to a different antidepressant (e.g., SNRI like venlafaxine) is usually reserved for non-response or intolerable side effects at maximal SSRI dose.
GAD SSRI Partial Response
If a patient with GAD shows partial improvement on an SSRI after an adequate trial and tolerates the medication, the first step is to increase the SSRI dose to achieve full remission.
- SSRI/SNRI are first-line for GAD.
- Adequate trial duration is 4-6 weeks at a therapeutic dose.
- Titrate to max tolerated dose for full response before switching or augmenting.
Memory trick: Start low, go slow, but if anxiety still shows, raise the dose, then consider more.