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Mary a 26 year of age Caucasian female is referred to you for depression. Given the rigorousness of her symptoms, you and the patient agree that she must be treated with a combination of psychotherapy and pharmacotherapy. Mary has never been treated for depression before, however her aunt Debbie was successfully treated with Imipramine (Tofranil) and was capable to tolerate the side effects much well. As you take the medical history, Mary informs you that there is a history in her family of cardiac arrhythmias, and that her heart "flutters" once in a while when she feels anxious. Given only this information, the best course of action is:

a) Start Mary on Imiprimine (Tofranil). Chances are that this medication will work for her.

b) Start Mary on Imiprimine (Tofranil) but as well recommend that she receive a cardiac workup.

c) Start Mary on a high dose of Citalopram (Celexa) to control both the depression and anxiety, and you might as well suggest that she receive a cardiac workup.

d) Start Mary on a low dose of Citalopram (Celexa) and you as well propose that she receive a cardiac workup.

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