Psychiatrymiddle twist
A 46-year-old carpenter has had a major depressive episode for seven months. He completed eight weeks of sertraline 100 mg daily with no change, then twelve weeks of venlafaxine 225 mg daily with no change. He is still working, has no psychotic symptoms and has never had a thought of ending his life. His wife is supportive and he is not drinking. Thyroid function, full blood count and liver function are normal, and he takes no other medicines. Which one of the following is the most appropriate next step in his care?