A 40-Year-Old Woman with Major Depression Comes to the Office

A 40-year-old woman with major depression comes to the office for follow-up.  She has been taking paroxetine daily for the past year.  The patient is doing fairly well but is concerned that she experiences periods of low mood on occasion.  When asked how she is taking the medication, she states, "I know the bottle says once a day, but I usually take an extra pill when I feel sad and skip it if I'm having a good day."  Vitals signs are within normal limits.  Physical examination shows no abnormalities.  Which of the following is the most appropriate next step in management?

A) Explain that the medication requires consistent dosing for optimal effect
B) Inform the patient that she has been taking the medication incorrectly
C) Obtain regular paroxetine serum levels and increase frequency of office visits
D) Provide clear oral and written instructions on how to take the medication
E) Recommend that she take the medication once daily as prescribed

Correct Answer:

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