Two weeks ago, the PMHNP prescribed the antidepressant escitalopram (Lexapro) for a 28-year-old female client with generalized anxiety disorder. At her initial appointment, she scored 28 on the Hamilton Anxiety Rating Scale (HAM-A). At today’s follow-up visit, she scored 26. She reports no side effects from the Lexapro. Which of the following is the next step for the PMHNP?

Choice A reason: Discontinuing the medication after only two weeks is premature. SSRIs like escitalopram typically require 4–6 weeks to achieve full therapeutic effect, so discontinuation at this point could prevent the patient from benefiting from treatment. Choice B reason: Making no changes is appropriate because the patient is within the early stages of treatment. Her HAM-A score decreased slightly, and she reports no adverse effects, indicating she is tolerating the medication and may continue to improve with time. Monitoring and follow-up are the correct next steps. Choice C reason: Adding an augmenting agent is unnecessary at this stage because the patient has only just begun therapy, and insufficient time has passed to determine the full effect of the SSRI. Augmentation is considered after an adequate trial of the primary medication. Choice D reason: Switching to a different antidepressant is not indicated because there has been some improvement in her symptoms and she is tolerating the medication well. A switch is premature before completing an adequate trial period.