A 42-year-old female with major depressive disorder is start…

A 42-year-old female with major depressive disorder is started on sertraline 50 mg daily. After one week, she develops severe hepatotoxicity, confirmed by markedly elevated liver enzymes on lab testing. She denies alcohol use, acetaminophen use, or any other medications. There is no prior history of liver disease. The reaction is unexpected given the usual safety profile of SSRIs. This is an example of a(n): 

Patient: 28-year-old femaleChief Complaint: “I feel exhauste…

Patient: 28-year-old femaleChief Complaint: “I feel exhausted and can’t focus.”History of Present Illness:The patient reports a 3-week period of depressed mood, low energy, hypersomnia, poor concentration, and feelings of worthlessness. She reports suicidal ideation with no plan/intent and acknowledges a prior suicide attempt “a very long time ago”. She reports a desire to get back to her “productive self” when she has more energy despite a little less sleep and can easily generate ideas though she admits she has difficulty with follow through. She report these periods of productivity occur sporadically and last about a week.  She denies psychotic symptoms. These episodes never cause severe impairment or hospitalization. Medical History: Unremarkable. Substance Use: Occasional alcohol, no illicit drugs.Family History: Mother with recurrent and severe depression; paternal uncle with “mood swings.” Mental Status Exam: Appearance: Appropriately dressed, tired-looking Speech: Slow, soft Mood: “Down” Affect: Constricted Thought Process: Logical No hallucinations or delusions Insight: Fair Which of the following is the most appropriate first-line medication for this patient?