Psychiatrymiddle twist
A 74-year-old woman has been in hospital for eleven days with a severe depressive episode. She is convinced her bowel has rotted away and that she is being punished, and for four days has refused all food and fluid. She is mute for long periods and has lost 7 kg. She has completed six weeks of sertraline 100 mg daily without benefit. Her urea is rising and she now requires intravenous fluids. She has no cardiac or respiratory disease. Which one of the following treatments is most likely to produce a rapid response?