Start amitriptyline 75 mg at bedtime

TCAs like amitriptyline are effective antidepressants but not first-line due to their dangerous toxicity in overdose, anticholinergic burden, and cardiac conduction risks. For a treatment-naive patient presenting with MDD, SSRIs and SNRIs offer comparable efficacy with a much safer side-effect profile. TCAs are reserved for treatment-resistant cases or specific indications like neuropathic pain.

Start phenelzine 15 mg three times daily

MAOIs are effective antidepressants but not a first-line option for most patients. Tyramine dietary restrictions and the long list of dangerous drug interactions make MAOIs a last-resort option after multiple other medication classes have failed. For a treatment-naive patient with MDD, the risk-benefit profile of MAOIs is far less favorable than SSRIs or SNRIs.

Start sertraline 50 mg daily

Sertraline is a well-established first-line choice for uncomplicated MDD. Strong evidence base, favorable side-effect profile, and safety in overdose. For a patient with no comorbidities and no prior treatment, starting with an SSRI is the appropriate initial treatment.

Start alprazolam 0.5 mg three times daily

Alprazolam is a benzodiazepine. It's not an antidepressant and doesn't treat the core symptoms of MDD. It also carries dependence and tolerance risks. Benzodiazepine monotherapy for depression is never appropriate.