Ramon is a 12-year-old male who was started on fluoxetine, 40 mg daily

Ramon is a 12-year-old male who was

started on fluoxetine, 40 mg daily, for major depressive disorder 6 weeks ago. At his 2-week follow-up he was feeling well with no adverse drug effects, and his dose was elevated from 20 to 40 mg. Today he presents for a routine follow-up visit. He reports that he has been “all wound up” and is frequently agitated. He cannot sleep well and has trouble focusing at school. His friends say that he gets upset quickly, and they are starting to avoid him. The most appropriate approach is to:

A. Taper the fluoxetine off and see if these symptoms improve
B. Add a mood stabilizer to the fluoxetine
C. Increase his dose of fluoxetine to 60 mg daily
D. Continue the current dose and reassess in 2 week

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