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A 79-year-old woman was started on sertraline three weeks ago for her first depressive episode. Her daughter brings her to the emergency department because over the past four days she has become drowsy, unsteady on her feet and, in the daughter's words, muddled, which is entirely new. She weighs 48 kg and also takes hydrochlorothiazide and ibuprofen. She is afebrile, her chest is clear and her urine dipstick is negative. There are no focal neurological signs, her tone and reflexes are normal, and she is not sweating. Which one of the following is the most likely explanation for her deterioration?
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