A 16-year-old pregnant adolescent has been treated for depression with cognitive behavioral therapy and fish oil, which contains omega- 3 fatty acids. The patient continues to have symptoms of depression. After further evaluation, the nurse practitioner should consider adding:

Rationale: A. St. John’s wort is not recommended during pregnancy due to limited safety data and potential drug interactions. B. SNRIs may be considered in adults but have less safety data in pregnancy compared with SSRIs. C. Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacologic therapy for depression during pregnancy when nonpharmacologic measures are insufficient. SSRIs like sertraline or fluoxetine have the most safety data for use in pregnant adolescents. D. Tricyclic antidepressants (TCAs) are generally reserved for cases unresponsive to SSRIs due to more adverse effects and risk of cardiotoxicity.