27-year-cid woman comes to the office due to persistent anxiety The patient is brought by her husband as she is no longer able to
drive. She is afraid that she will have a panic attack while driving and could faint and lose control of the car. The patient used to have
panic attacks several times a week that were characterized by sudden onset of palpitations, sweating, and dizziness. She started
medication a year ago, and the panic attacks have since resolved. However, the patient now has anxiety any time she has to leave
the house. She has been reluctant to look for work, has stopped going to the gym, and frequently relies on her husband for
transportation. The patient has no other medical problems She takes citalopram 20 mg Physical examination is oormal. The
patient drinks 2 cups of coffee in the morning and a glass of wine at night She does not use illicit drugs Review of systems shows a
weight gain of 2.3 kg (5 lb), which the patient attributes to lack of exercise. Which of the following is the most appropriate next step in
management ofthis patient?
- QA Add clonazepam as needed
- QB Add cognitive-behavioral therapy
- QC Add supportive psychotherapy
- QD lncrease dose ofcitalopram
- Q E Switch to bupropion
- Q F. Switch to fluoxetine
- Q G Switch to venlafaxine
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