A nurse is caring for a client who has major depressive disorder and was prescribed citalopram 2 weeks ago with a planned dosage increase 1 week ago. The client reports having an improved appetite, but still feels very depressed and is still having trouble sleeping. Which of the following actions should the nurse take?

Choice A reason: Recommending a sleep study is not appropriate at this stage. The client’s insomnia is likely related to ongoing depressive symptoms and the fact that the antidepressant has not yet reached full therapeutic effect. Sleep studies are indicated for suspected sleep disorders such as sleep apnea, not for early antidepressant treatment response. Choice B reason: Changing citalopram to a different medication after only 2 weeks is premature. Antidepressants typically require 4 to 6 weeks to achieve full therapeutic effect. Early discontinuation or switching medications before this period may prevent the client from experiencing the intended benefits. Choice C reason: Antidepressants, including SSRIs like citalopram, often take several weeks to reach full effectiveness. Improvement in appetite is an early positive sign, but mood and sleep symptoms may take longer to improve. The nurse should educate the client about this expected timeline to promote adherence and realistic expectations. This is the correct answer. Choice D reason: Adding an MAOI to the current regimen is contraindicated due to the risk of severe drug interactions, including serotonin syndrome and hypertensive crisis. MAOIs must never be combined with SSRIs. This option is unsafe and inappropriate.