An 82-year-old man with a long history of depression has been treated over the years with various pharmacologic agents with little improvement. Last week the PMHNP decided to try vortioxetine as the patient is clearly despondent, has not responded to several SSRI options, and is not interested in discussing ECT. At this visit the patient appears markedly brighter. He engages in conversation, has been more active with his peers at the assisted living facility, and overall seems much improved. He has no adverse effects and actually reports improved bowel motility.

The PMHNP considers that:

A. The SSRI/SPARI combination has improved the patient in a way that the SSRI alone did not.

B.  The patient may be planning suicide and a suicide screening should be implemented

C. It is likely a placebo effect from a new medication as it is unlikely therapeutic after one week

D. It may actually be an impending manic episode that has not been diagnosed previously
---
YouTube: https://www.youtube.com/watch?v=apxLdU_UCFA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=46