Soru

An 18-year-old female university freshman is evaluated at the student health center. Her roommate insisted she be seen because, over the last five weeks, the patient has been skipping classes, crying uncontrollably, and sleeping excessively. The patient reports severe anhedonia, a significant increase in appetite resulting in a 5-kg (11-lb) weight gain, and a sensation of profound physical heaviness in her limbs. Review of her medical records reveals a psychiatric hospitalization eight months ago. During that admission, which lasted 14 days, she exhibited pressured speech, severe psychomotor agitation, an almost complete lack of sleep, and auditory hallucinations commanding her to lead a new global government. She was stabilized and discharged, but subsequently stopped attending follow-up appointments. Three weeks ago, she visited an urgent care clinic for her current depressive symptoms and was started on daily citalopram. She has taken the medication faithfully but reports no improvement in her mood. Vital signs and physical examination are within normal limits. She denies any illicit substance use. Which of the following is the most appropriate pharmacological recommendation at this time?