# A nurse is caring for a client with major depressive disorder who has been prescribed sertraline (Zoloft) 50 mg daily. The client reports feeling "much better" after 5 days of treatment and asks to discontinue the medication. What is the most appropriate nursing response?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543366  
> language: ko  
> subject: Mental Health

## 문제

A nurse is caring for a client with major depressive disorder who has been prescribed sertraline (Zoloft) 50 mg daily. The client reports feeling "much better" after 5 days of treatment and asks to discontinue the medication. What is the most appropriate nursing response?

## 보기

1. Explain that antidepressants require 4-6 weeks to reach full therapeutic effect and emphasize the importance of continuing the medication as prescribed. **✔ 정답**
2. Support the client's decision since they are feeling better and suggest they can restart the medication if symptoms return.
3. Recommend reducing the dose to 25 mg daily since the client is responding well to treatment.
4. Advise the client to consult with their psychiatrist before making any changes to the medication reg

**정답: 1**

## 해설

Antidepressants like sertraline require 4-6 weeks for full effect; early discontinuation risks relapse. The nurse must educate on compliance and therapeutic timeline.

## 심화 해설

Therapeutic Response Timeline for SSRIs

The client's perception of improvement after only 5 days reflects an initial physiological response, not the full therapeutic effect required for sustained remission. Sertraline, a selective serotonin reuptake inhibitor (SSRI), begins blocking the reuptake of serotonin at the synaptic cleft shortly after administration. However, the clinical antidepressant effect relies on downstream neuroplastic changes, including the desensitization of presynaptic autoreceptors and the upregulation of postsynaptic receptors, a process that takes significantly longer . This explains the well-established clinical guideline that antidepressants require 4 to 6 weeks to achieve their full therapeutic potential. Premature discontinuation based on early, often placebo-related or transient mood elevation, places the client at high risk for relapse and incomplete recovery.

Risk of Abrupt Discontinuation

Supporting the client's decision to stop the medication abruptly is contraindicated due to the risk of a well-documented physiological phenomenon. Abrupt cessation of SSRIs can precipitate a withdrawal syndrome, characterized by sensory disturbances, disequilibrium, and flu-like symptoms, which can be mistaken for a recurrence of the depressive episode [1]. This physiological dependence is distinct from addiction and requires clinical management. The decision to discontinue an antidepressant should only be considered when the recommended duration of therapy is complete and there is no clinical indication for continued use, or when adverse effects definitively outweigh therapeutic benefits [1]. A subjective feeling of being "much better" after 5 days does not meet either criterion.

Medication Adherence and Shared Decision-Making

Non-adherence is a significant barrier to achieving remission in major depressive disorder, often driven by a lack of understanding regarding the treatment timeline and medication necessity . The most appropriate nursing action is to provide psychoeducation that bridges the gap between the client's subjective experience and the pharmacological reality. While the client's ultimate decision-making authority is respected, the nurse's role is to explain the mechanism of action, correct misconceptions about the speed of recovery, and emphasize the importance of continuing the medication as prescribed to prevent relapse. Recommending a dose reduction or advising a consultation without first providing essential education fails to address the core knowledge deficit driving the request. The nurse must first reinforce the treatment rationale, explaining that the current dose is a standard therapeutic starting point and that altering the regimen without a full therapeutic trial undermines the treatment's purpose and increases the risk of a prolonged or recurrent depressive episode [1].References (research sources)

- [1]Stopping antidepressants: when and how.Research articleWallis KA. (2026) · DOI: 10.18773/austprescr.2026.019

## 임상 시나리오

SSRI Therapy: Managing Early ResponseEducating on Therapeutic Lag and Adherence
When a client reports feeling better within the first week of starting an SSRI like sertraline, acknowledge the improvement but clarify this is an initial physiological effect, not full remission. The therapeutic lag for antidepressants is 4–6 weeks.

The core nursing action is to reinforce the importance of continuing the medication as prescribed to allow for neuroplastic changes that sustain mood improvement. Frame adherence as a critical step in preventing relapse.

CautionNever support abrupt discontinuation. Abruptly stopping an SSRI can precipitate discontinuation syndrome (dizziness, nausea, sensory shock-like sensations), which can be mistaken for a return of depression. Any dose change requires a planned taper under psychiatric supervision.

## 핵심 개념

- **Major Depressive Disorder** — Major depressive disorder. A mood disorder characterized by persistent depressed mood, loss of interest, fatigue, changes in sleep/appetite, suicidal thoughts, etc.
- **Sertraline** — Selective serotonin reuptake inhibitor (SSRI) class antidepressant. It treats depression, anxiety disorders, etc. by increasing serotonin levels in the brain.
- **Therapeutic Effect / Onset of Action** — Onset of therapeutic effect / action. For SSRI antidepressants, mood improvement usually begins after 2-4 weeks, and it takes 4-6 weeks to see the full therapeutic effect.
- **Medication Adherence / Compliance** — Medication compliance. The degree to which a patient takes medication as prescribed. In the treatment of mental illness, low compliance is a major cause of relapse and hospitalization.
- **Discontinuation Syndrome / Withdrawal** — Drug discontinuation syndrome / withdrawal symptoms. Symptoms such as dizziness, headache, insomnia, agitation, and 'brain zaps' that can occur when an SSRI is abruptly stopped.

## 같은 주제 문제

- [A nurse is assessing a 45-year-old client who was admitted to the psychiatric unit with a …](https://mymerci.kr/pages/nclex_q.php?qn_id=543364)
- [A nurse is caring for a client with bipolar disorder who is experiencing a severe manic ep…](https://mymerci.kr/pages/nclex_q.php?qn_id=543365)
- [A nurse is caring for a 45-year-old client with major depressive disorder who has been tak…](https://mymerci.kr/pages/nclex_q.php?qn_id=543367)
- [A nurse is caring for a client with schizophrenia who is experiencing auditory hallucinati…](https://mymerci.kr/pages/nclex_q.php?qn_id=543368)
- [A nurse is caring for a client with generalized anxiety disorder who has been expressing s…](https://mymerci.kr/pages/nclex_q.php?qn_id=543369)
- [A nurse is caring for a client with major depressive disorder who has been expressing suic…](https://mymerci.kr/pages/nclex_q.php?qn_id=543370)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._