A 22-year-old female patient is transferred to your care after another provider in the practice retired. She has been managed for bipolar I disorder for 3 years and has had some challenging extremes of exacerbation. She is currently taking a mood stabilizer, an antipsychotic, and an antidepressant. Today she reports a worsening of her depression, admitting to true hopelessness about the future, worsening malaise to the extent that she is not attending to basic hygiene, and for the first time reporting passive suicidal ideation. While her ideation does not rise to the level of hospitalization, it is a new and concerning symptom. 

Which of the following is the most appropriate adjustment to the plan of care? 

A. Ensure that the patient is seeing a therapist. 

B. Adjust the medication regimen to include lithium.

C. Increase the dose of the antidepressant.

D. Change to a different antidepressant. 

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