A 48-Year-Old Man Walks in with His Wife for a Check-Up

A 48-year-old man walks in with his wife for a check-up on his serious depressive condition. The patient had been on sertraline for two years before beginning bupropion and weekly cognitive behavioral therapy three weeks ago owing to a relapse of depression. Since then, his energy level has improved, and he is working on communicating more with his wife about his emotions. The patient has no suicidal ideation and is hopeful that he will feel better with continued treatment. A week later, his wife calls the office and states that her husband died by suicide a few days ago. She is tearful on the phone and says, "I thought that he was doing better. I don't understand how this happened." Which of the following is the most appropriate response?

A) "He seemed hopeful about his treatment when I last saw him; do you know whether he was taking his medication as prescribed?"
B) "I can't imagine how difficult this must be for you; I'm here to answer questions you may have about your husband's illness and treatment."
C) "I'm so sorry to hear about this; he seemed to be improving, but there can be a risk of suicidal thoughts with medication changes."
D) "I'm very surprised by this too, given how well he was doing at his last appointment; can you tell me more about what happened?"
E) "This is definitely upsetting and shocking, and I did not see this coming.  Did you notice anything unusual the week leading up to his suicide?"