JR is a 35 y/o female that presents to your clinic seeking help for her depressed mood. After evaluating her, you diagnose JR with major depressive disorder and prescribe her citalopram, an SSRI. Which counseling point is important to relay to JR? Select one:

Selective serotonin reuptake inhibitors (SSRIs) are commonly used as first-line treatment for major depressive disorder because they improve mood by increasing serotonin availability in the brain. Patient education is important to improve adherence, especially during the first few weeks when side effects may occur before full therapeutic benefit is noticed. Many patients discontinue therapy early if they are not prepared for these temporary effects. Proper counseling helps improve treatment success and reduces unnecessary medication discontinuation. Rationale: A. Rising slowly from a lying or sitting position is more commonly emphasized with tricyclic antidepressants or antihypertensive medications that frequently cause orthostatic hypotension. Although SSRIs may occasionally cause dizziness, orthostatic hypotension is not a major expected adverse effect of Citalopram. This is not the primary counseling point that should be emphasized for routine SSRI initiation. B. Citalopram should not be titrated rapidly every 2 days because antidepressants require gradual dose adjustments and time to assess response and tolerance. Rapid titration increases the risk of adverse effects such as serotonin syndrome, QT prolongation, and patient intolerance. Clinical improvement also takes several weeks, so aggressive dose escalation is inappropriate. C. Minor side effects such as nausea, mild somnolence, headache, and insomnia are common during the early phase of SSRI treatment and are usually temporary. These symptoms often improve within 1 to 2 weeks as the body adjusts to the medication. Educating the patient about this helps reduce anxiety, improves adherence, and prevents premature discontinuation before therapeutic benefits are achieved. D. Abrupt discontinuation of SSRIs can lead to discontinuation syndrome, which may include dizziness, irritability, flu-like symptoms, and sensory disturbances. Although some SSRIs with longer half-lives have lower risk, citalopram still requires gradual tapering rather than sudden cessation. Patients should always be instructed not to stop the medication suddenly without provider guidance.