A 50 -year-old female patient has been followed by the PMHNP for over 6 years for a diagnosis of major depressive disorder, recurrent. The patient has achieved a successful remission on sertraline, 75 mg daily.  Today presents complaining of an acute onset depressed mood, tearful days, and difficulty concentrating for the last month. It has become a problem at work, and her boss has suggested that she might need to take some time off to “take care of her problem.”  Further discussion reveals that the patient learned last month that her husband is having an affair with a coworker.  She is so distraught and consumed that she cannot fulfill her work responsibilities and she has completely cut herself off socially from friends and family. 

The PMHNP suggests that the next best step in her care should include which of the following? 

A. Increasing her sertraline to 100 mg daily 

B. A referral to psychotherapy

C. A referral to couples counseling 

D. Changing her pharmacotherapy to an SNRI 

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