A 36 year-old male comes to your clinic for the evaluation of his ongoing medical problems. He lost interest in activities that used to give him pleasure. He denies any suicidal thoughts but life feels like he entered into an uncharted territory with no meaning and purpose. He can’t fall asleep easily and has difficulty staying asleep. He feels sleepy early in the morning when it is time to go to work. He feels miserable because the sleep won’t come when he needs it and comes when he does not need it. He thinks his recent divorce drained ‘all life out of me’ and feels he has low energy. He is responsible to pay the full mortgage on his now. And his anxiety is ‘going through the roof’. He does not have a good appetite. Even when he forces himself to eat, he feels early fullness in stomach, excessive bloating, belching and nausea. He had lost 8 pounds during the last 2 months. He used paroxetine for a few months but it did not help him much and caused sexual dysfunction. His past medical history is significant for a 10 years history of tension headaches which come 3-4 times a week. Which of the following is the best medication to treat his symptoms on a long-term basis?
