A 30-year-old woman at 10 weeks gestation presents with worsening major depressive disorder. She has a history of two prior major depressive episodes, the most recent requiring hospitalization for suicidal ideation. She was stable on sertraline 150 mg daily for 18 months prior to discontinuing it upon discovering her pregnancy 4 weeks ago. She now reports persistent depressed mood, anhedonia, poor appetite with weight loss, and passive suicidal ideation. The PMHNP must weigh the risks and benefits of resuming antidepressant therapy.