Soru

A 61-year-old retired engineer is brought to the physician by his daughter for a psychiatric evaluation. Over the past five weeks, he has become increasingly withdrawn, spending most of the day in bed. He reports waking up at 3:00 AM daily and being unable to return to sleep. His daughter notes he has lost approximately 5.5 kg (12 lb) during this period and no longer shows interest in his usual hobbies, such as gardening. Two weeks ago, the patient's primary care provider diagnosed him with a major depressive episode and prescribed fluoxetine. The patient states he feels no better and wants to discontinue the medication. Upon further questioning, the daughter recalls that when her father was in his late thirties, he was briefly given a different antidepressant for sadness. Within days of starting that medication, he became excessively talkative, slept only two hours a night for a week, and impulsively bought three luxury vehicles, leading to a brief psychiatric hospitalization. Medical history is otherwise unremarkable, and he takes no other medications. Vital signs are within normal limits. Which of the following is the most appropriate next step in management?