A 30-year-old woman at 14 weeks gestation with a history of recurrent major depressive disorder presents with worsening depressive symptoms. She was stable on sertraline 100 mg prior to pregnancy but discontinued it upon learning she was pregnant at 6 weeks. She now has a PHQ-9 of 22, poor oral intake, insomnia, and passive suicidal ideation without plan or intent. She is concerned about medication effects on her baby.