Patient is a 45-year-old female with a history of major depressive disorder and generalized anxiety disorder presented for evaluation of recent worsening of underlying depression and anxiety with a recent decline in energy, interest, appetite, sleep with evident psychomotor retardation but denies suicidal ideations and no current or past history of manic or psychotic symptoms. The patient is stable on sertraline 100 mg daily dose for the last 8 weeks.

Substance abuse history: drinks 1-2 beers every weekend. no other substance abuse. 

Medical History:
- Hypertension (treated with hydrochlorothiazide)
- GERD (treated with cimetidine)
- Seizure disorder (treated with phenytoin)

Laboratory workup:
- CBC (complete blood count): platelets (80,000 per μL) with normal WBC and hemoglobin.
- Kidney function and Liver function test: in a normal range. 
- TSH: in a normal range. 

(Q.1): Which of her current medications are associated with the risk of thrombocytopenia?

(Q.2): Patient is currently asymptomatic from thrombocytopenia standpoint (no bleeding, bruising or petechiae). 
Family history of thrombocytopenia: none.
Patient's childhood history of thrombocytopenia: none.

Which of the following management option should be your first step in this patient's thrombocytopenia evaluation?

(Q.3) Which of the following antidepressant is likely to be a safer option in this patient?


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