For a patient with their first episode of major depression with no medical history, what class of drug should be the first choice for treatment?

Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for a patient experiencing their first episode of major depression, especially when there is no medical history. SSRIs are favored because they have a favorable side effect profile, making them more tolerable for patients compared to older classes of antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

SSRIs work by increasing the availability of serotonin in the brain, which has a positive impact on mood and emotional regulation. Evidence supporting their efficacy and safety in both short-term and long-term use makes them the preferred choice for new-onset depression.

The other classes of drugs present certain limitations, such as the higher adverse effect burden associated with TCAs, which can include sedation, anticholinergic side effects, and cardiovascular issues. MAOIs, while effective for certain cases of depression, are less commonly used due to dietary restrictions and significant drug interactions. NDRIs may be considered in specific situations, such as when SSRIs fail or if a patient has particular symptoms like fatigue or sexual dysfunction, but they are not the first choice for treating a new episode of depression. Thus, SSRIs remain the recommended initial treatment