A patient started on fluoxetine two weeks ago reports increased anxiety and no mood improvement. What is the most appropriate course of action?

• A. Continue fluoxetine for another 2 weeks and reassess
• B. Stop fluoxetine immediately
• C. Increase the dose
• D. Switch to another antidepressant

Answer: (D)

Antidepressants need several weeks to show their full benefit, and some SSRIs can cause initial activation, like increased anxiety. If, after two weeks, there’s no mood improvement and anxiety is worse, it signals that the current medication isn’t providing relief and may be poorly tolerated. In this situation, continuing the same drug or simply raising the dose is unlikely to help and could worsen distress or side effects. Abruptly stopping isn’t ideal either, as it can cause withdrawal symptoms and leaves depression untreated. Switching to another antidepressant with a different mechanism or tolerability profile gives the patient a better chance of symptom relief while addressing the anxiety.