Soru

A $42$-year-old male construction manager presents to the clinic accompanied by his wife. He reports a $6$-week history of feeling "completely hollow," sleeping up to $14$ hours a day, having a ravenous appetite, and experiencing severe heavy feelings in his arms and legs. He has gained $7$ kg ($15.4$ lbs) during this period. Review of his medical history reveals an incident four years ago where he went $8$ days sleeping only $2$ hours a night, became convinced he was chosen by a deity to build a new city, and spent $40,000$ dollars of his savings on barren land. This episode resulted in an involuntary psychiatric hospitalization. He stopped taking all prescribed medications three years ago. His vital signs are normal, and a recent comprehensive metabolic panel and thyroid-stimulating hormone (TSH) level of $2.2$ $\mu$ U/mL (normal: $0.4$-$4.0$ $\mu$ U/mL) are unremarkable. Which of the following is the most appropriate next step in pharmacotherapy for this patient's current presentation?