A 79-year-old man with a history of major depressive disorder, type 2 diabetes, osteoarthritis, and a recent hip fracture repaired six weeks ago is being seen for follow-up after starting sertraline 25 mg daily four weeks ago. His depressive symptoms have shown minimal improvement, and he continues to report persistent sadness, loss of interest, fatigue, and poor sleep. He takes metformin, lisinopril, amlodipine, and was recently started on naproxen by his orthopedist for persistent hip pain. His sodium level was 142 mEq/L at baseline. He denies suicidal ideation. The PMHNP is considering the next step in medication management.