A 48-year-old male with a history of major depressive disorder has been taking citalopram 20 mg daily for 6 weeks. He reports only a partial improvement in his mood and continues to experience significant anhedonia and low energy. He tolerates the medication well. What is the most appropriate next step in his treatment?

Question: A 48-year-old male with a history of major depressive disorder has been taking citalopram 20 mg daily for 6 weeks. He reports only a partial improvement in his mood and continues to experience significant anhedonia and low energy. He tolerates the medication well. What is the most appropriate next step in his treatment?

Answer options:

• Continue citalopram 20 mg daily for another 6 weeks. ✅ Increase citalopram to 40 mg daily.
• Switch to bupropion XR 150 mg daily.
• Add olanzapine 5 mg daily.

Correct answer: Increase citalopram to 40 mg daily.

Explanation: After an adequate trial (typically 4-6 weeks) of an antidepressant with only partial response, increasing the dose of the current medication (up to the maximum recommended dose) is a common and appropriate strategy before considering a switch or augmentation, assuming good tolerability. Citalopram can be increased to 40 mg daily.