A male patient on fluoxetine for five weeks still feels depressed. What should the next step be?

In the context of managing depression with fluoxetine, the decision to increase the dose is appropriate if the patient has been on the medication for a sufficient period (as in this case, five weeks) and is still experiencing symptoms of depression. Fluoxetine is an SSRI that typically takes several weeks to reach its full therapeutic effect, but if the patient continues to feel depressed after this duration, it may indicate that the current dose is insufficient for their needs.

Increasing the dose can help achieve the desired therapeutic effect by enhancing serotonin availability, which is often central to improving mood and alleviating depressive symptoms. It is crucial to consider the patient's overall response to the medication and their tolerance of any side effects before making this decision.

In many cases, practitioners will recommend a dose adjustment before considering a switch to an alternate medication or additional therapies. This approach allows for a stepwise management of the patient's condition and can often lead to improved outcomes without unnecessary changes to their treatment plan or referrals, especially when addressing the complexities of depression management.

While cognitive behavioral therapy and referring to a psychiatrist may also be valuable components of a comprehensive treatment plan for depression, adjusting the medication dosage is often the first-line action if a patient has not responded adequately to the initial treatment protocol after an appropriate duration