Problem:
Twelve weeks ago, your 35 year old patient presented with months of depressed mood, lack of energy, excess sleepiness and apathy. Her thyroid-stimulating hormone and complete blood count revealed no significant findings. You referred her for cognitive behavioral training and prescribed citalopram 10 mg daily. Four weeks ago, you increased her dose of citalopram to 20 mg daily as she was tolerating it without significant adverse effects but had not noticed any improvement in her symptoms. She presents today stating she has yet to notice any significant improvement in her symptoms. She continues to take the medication daily and sees her psychologist every other week. Which of the following is most appropriate? Group of answer choices Discontinue citalopram and start amitriptyline 10 mg daily; follow up in 2-4 weeks Maintain current dose of citalopram and co-prescribe escitalopram 10 mg daily; follow up in 2-4 weeks Maintain current dose of citalopram and co-prescribe milnacipran, 12.5 mg daily; follow up in 2-4 weeks Start duloxetine 20 mg daily while you taper down citalopram over the next 2-4 weeks; follow up in 2-4 weeks