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A 31-Year-Old Woman Comes to the Office for Follow-Up Treatment

question 59

Multiple Choice

A 31-year-old woman comes to the office for follow-up treatment of major depressive disorder. Five months ago, the patient attempted suicide by hanging after learning that her husband had filed for divorce. She was admitted to a psychiatric unit, where she was treated with fluoxetine 20 mg and discharged 2 months later. A month following discharge, the fluoxetine dosage was increased. The patient now says that her suicide attempt was "stupid" and denies suicidal ideation. However, despite taking maximum doses of fluoxetine for 8 weeks, she still feels very depressed and reports minimal improvement in her energy level, motivation, and concentration. The patient has ongoing feelings of guilt regarding the impact of her suicide attempt on her mother and young children. Other medical conditions include a history of bulimia nervosa and allergic rhinitis. Family history is significant for bipolar disorder in her mother. Mental status examination reveals poor eye contact, constricted affect, and soft speech. Which of the following is the most appropriate next step in the pharmacologic management of this patient's depression?

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Job Evaluation Manuals

Written guides that provide a systematic approach to determining the relative worth of jobs within an organization by outlining criteria, methodologies, and procedures.

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An outside company or individual that offers a specific service to an organization, often in areas where the organization lacks expertise or resources.

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