First-line pharmacotherapy for major depressive disorder is best described as

• A. CBT alone
• B. SNRI monotherapy
• C. MAOI with psychotherapy
• D. SSRI (e.g., sertraline) with psychotherapy

Answer: (D)

For major depressive disorder, a strong first-line approach combines pharmacotherapy with psychotherapy. An SSRI such as sertraline is preferred because it provides solid antidepressant efficacy with a favorable safety and tolerability profile. Adding psychotherapy—examples include cognitive-behavioral therapy or interpersonal therapy—addresses underlying thought patterns, coping skills, and functioning, and it improves overall response and lowers relapse risk compared with either treatment alone. MAO inhibitors carry dietary restrictions and more adverse effects, making them not first-line, and psychotherapy alone may be insufficient for many patients with moderate to severe depression. Therefore, the best description is an SSRI used together with psychotherapy.