A 29-year-old pregnant woman is referred to the PMHNP for management of anxiety and depression. She has been taking paroxetine 40 mg daily as an outpatient for several years prescribed by her primary care provider. Upon learning that the patient was pregnant, the primary care provider insisted that the patient consult with mental health for continued management. The patient is clear that she needs to continue pharmacotherapy. She had a baby 3 years ago and tried to stop taking medication and her condition deteriorated rapidly.

The most appropriate approach for the PMHNP would be to:

A. Advise the patient that psychodynamic psychotherapy is her safest option

B. Continue the paroxetine as ordered

C. Reduce the paroxetine gradually to 20 mg daily for the duration of pregnancy

D. Stop the paroxetine and begin sertraline
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