A 40-Year-Old Lady Suffering from Serious Depression Visits the Doctor

A 40-year-old lady suffering from serious depression visits the doctor for a check-up. For the last year, she has been taking paroxetine on a regular basis. The patient is doing well, although she is concerned that she has episodes of depression on occasion. "I know the package says once a day, but I normally take an additional tablet when I'm unhappy and skip it if I'm having a nice day," she replies when asked how she takes the drug. The vital indicators are within normal ranges. A physical examination reveals no anomalies. Which of the following management steps is the most appropriate next step?

A) Explain that the medication requires consistent dosing for optimal effect
B) Inform the patient that she has been taking the medication incorrectly
C) Obtain regular paroxetine serum levels and increase frequency of office visits
D) Provide clear oral and written instructions on how to take the medication
E) Recommend that she take the medication once daily as prescribed