The answer is to increase the dose of the medication (Choice 1). In most cases where there is a significant response seen, dose adjustment is adequate therapy. Adding or reducing doses may not be a good thing for fear of interactions and side effects. This is particularly true with elderly patients.

Choice 2 is incorrect as most of the response is obvious in the first 3-4 weeks. This makes waiting any longer on the same dose almost a futile exercise.

Choice 4 is incorrect as this medication has already helped the patient and it is unnecessary to try a new medication at this time.

The patient is known to be depressed for 4 years. It is not important to review stressors as they are anyway a weak catalyst for long-term depression. Although they may be important in depression with onset that is less than 6 months.