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Optimizing (i.e., raising)
the dose is a reasonable first step if side-effect burden is tolerable,
especially if the upper dosage limit has not yet been reached.
Some patients may require doses higher than those approved by
the Food and Drug Administration.
In patients who have shown a partial response, particularly
those who have features of personality disorders and prominent psychosocial
stressors, extending the antidepressant medication trial (e.g.,
by 4–8 weeks, but not indefinitely) can be considered.
As for patients treated
with an antidepressant, an initial strategy is to increase the intensity
of treatment (i.e., increase the frequency of psychotherapy sessions).
The appropriateness of the type of psychotherapy used
and the quality of the therapeutic alliance should be reviewed.