Medication Change

A 32-year-old female patient with diagnoses of bipolar I disorder and borderline personality disorder was recently transferred to your care. She was managed on desvenlafaxine ER 150 mg daily and olanzapine 10 mg daily but experiencing increasingly elevated mood. In an attempt to wean off desvenlafaxine you reduce her from 150 mg to 100 mg daily. She experiences profound discontinuation syndrome symptoms. What is the most appropriate approach?

A. Resume desvenlafaxine ER 150 mg daily

B. Add valproic acid 750 mg daily

C. Increase olanzapine to 15 mg daily

D. Begin fluoxetine 20 mg daily
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