A 37-year-old man has been coming to you for a month for management of depression that has not improved despite "years of wasted psychiatrist visits." You prescribed a full dose of fluoxetine 4 weeks earlier after you ruled out a medical etiology for his condition. He returns today to tell you that he has not noticed any improvement in his mood, energy level, or ability to concentrate. He promises you that he is taking the medication exactly as prescribed and that he is not drinking any alcohol. Physical examination is unremarkable. He denies any suicidal ideation and does not have any psychotic symptoms. He really wants you to prescribe a different medication. At this time you should
A. add buspirone to his current treatment regimen
B. advise him to go back to his psychiatrist
C. explain that fluoxetine requires at least 5 weeks to reach a steady state and that treatment response should be reevaluated in 2-4 weeks
D. recommend that he taper the medication over a week and initiate a trial with a different agent
E. tell him that the medication is probably not working because he has a negative attitude
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