Soru

A $31$-year-old man presents via telehealth for an initial psychiatric evaluation. He reports a $7$-week history of persistent low mood, extreme lethargy, and a $6$-kg ($13$-lb) weight gain. He sleeps up to $15$ hours a day and describes his limbs as feeling 'unnaturally heavy.' For the past $2$ weeks, he has also been hearing a distinct, critical voice telling him he is 'toxic and contagious' whenever he is alone in his room. Upon detailed psychiatric history taking, he reveals that $3$ years ago, he was hospitalized for a $10$-day period during which he believed he was a divine messenger, slept only $1$ hour per night, and paced the streets preaching. He was stabilized and discharged but stopped his prescribed medications shortly afterward. He recently began taking a high-dose over-the-counter St. John's wort supplement to improve his mood, but it has provided no relief. A recent primary care blood panel shows a thyroid-stimulating hormone (TSH) level of $2.1$ mU/L (normal: $0.5$-$5.0$) and a free thyroxine (T4) level of $1.1$ ng/dL (normal: $0.8$-$1.8$). Which of the following is the most appropriate next step in the management of this patient?