A 32-Year-Old Woman at 16 Weeks Gestation with No Previous

A 32-year-old woman at 16 weeks gestation with no previous medical or psychiatric history comes to the office for a follow-up due to worsening depression.  She says, "I don't understand why I feel this way since I was so happy to become pregnant and my fiancé is very supportive.  Sometimes I start crying over nothing at all."  The patient began seeing a therapist 8 weeks ago after her sister noticed that she seemed down.  She had suicidal thoughts at that time, but has been able to control these by speaking with the therapist weekly.  The therapy has helped somewhat, but the patient still feels depressed most of the day, has trouble sleeping, and wakes up early in the morning.  She is also having trouble concentrating at work and has lost 2.5 kg (5.5 lb) over the past 4 weeks.  She has no current suicidal or homicidal thoughts or psychotic symptoms.
Physical examination is unremarkable and laboratory studies, including complete blood count and TSH, are within normal limits.
Which of the following is the most appropriate treatment for the patient at this time?

A) Electroconvulsive therapy
B) Increased frequency of psychotherapy sessions
C) Mirtazapine
D) Sertraline
E) Venlafaxine

Correct Answer:

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