What is the typical pharmacologic progression for treating depressive disorder?

• A. MAOIs prescribed by psychiatrists
• B. SSRIs alone are the first-line
• C. SSRIs then SNRIs then TCAs then MAOIs (MAOIs prescribed by psychiatrists)
• D. SNRIs

Answer: (C)

Starting with a selective serotonin reuptake inhibitor is common because it offers effective relief with a favorable safety and tolerability profile. If there's an inadequate response after a proper trial, clinicians typically switch to or add an agent with a different mechanism, often an SNRI. If still not achieving remission, a tricyclic antidepressant may be tried, though it carries more adverse effects and safety concerns. As a last option, a monoamine oxidase inhibitor is considered, given its dietary restrictions and interaction risks and the need for close monitoring, usually by a psychiatrist. This stepwise escalation—from SSRI to SNRI to TCA to MAOI—reflects how treatment progresses from first-line tolerability to progressively more complex and higher-risk options when earlier steps fail.