A 29-year-old woman who you have been treating for bipolar disorder comes to the office because of feelings of "sadness" over the past few months. She has been taking lithium carbonate for 3 years and has not had any "periods of sadness" or manic episodes requiring hospitalization since starting therapy. Before that time, she had been hospitalized 4 times for manic episodes. She feels "sluggish" and tired and has difficulty concentrating at the office. Her skin is dry and cool, but the remainder of the examination is unremarkable.
The most appropriate action at this time is to
A. add St. John's wort
B. add fluoxetine to her current therapy
C. order TSH.
D. discontinue lithium carbonate therapy
E. lower the dose of lithium carbonate
F. make no changes in therapy
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