A 31-year-old accountant comes to your clinic with 5 weeks of low mood, sleeping up to 11 hours a night, poor concentration and feelings of guilt. She denies psychotic symptoms and suicidal thoughts. She asks for sertraline because it helped her sister. On further history, she describes two episodes in the past 3 years, each lasting about 5 days, when she needed only 3 hours of sleep, spoke rapidly, felt unusually confident and made risky investments that her friends noticed; she continued to work and was never hospitalized. She takes no medications, has no allergies and does not use alcohol or drugs. Examination is unremarkable and TSH is 2.1 mIU/L (0.4-4.0).
| Heart rate | 68/min |
| Respiratory rate | 14/min |
| Temperature | 36.8 °C |
| O2 saturation | 99%, room air |
| Blood pressure | 112/70 mm Hg |
Question 1 of 30
Which one of the following is the most appropriate first-line therapy for her current episode?
Select 1. (0 / 1 selected)
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