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A 27-year-old woman is evaluated in the office because she thinks she may be depressed. She reports feeling fatigued and having a sad mood often. However, she denies anhedonia, psychomotor slowing, difficulty with sleep or appetite, or problems with concentration. She denies any suicidal ideation. She just started a new job as a school counselor and is already starting to feel significant stress, often working long hours. She feels guilty for not spending enough time with her 2-year-old daughter and husband. She has no other medical history and does not take any medications. She denies tobacco use, drinks 1-2 glasses of wine per week, and does not use illicit drugs.

On physical exam, she is alert and oriented, demonstrates appropriate affect. The remainder of her examination is unremarkable. Her basic laboratory work is normal including blood count, electrolytes, urinalysis, and thyroid-stimulating hormone levels.

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

  1. Follow up monitoring
  2. Begin sertraline
  3. Begin nortriptyline
  4. Refer for psychotherapy

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1. Source: "Comparative Analysis of Pre/Post Assessments of Live/Didactic Course Attendees when compared to Mico-Learning/Online Course Users., "Knowledge to Practice, 2017.