We don't follow this PMHNP's line of thinking at all. Here we have a 16-year-old patient with a known history of depression and hospitalization for self-injurious behavior and suicidal ideation, once again actively demonstrating self-injurious behavior (cutting), and this NP's first thought is to switch up the medications? Well, isn't that just phenomenal. Shall we wait a few weeks for the new meds to kick in and see what happens? Hopefully this poor teenager doesn't hurt herself too badly...or worse. This patient needs emergent psychiatric evaluation in the ER, if not an inpatient psychiatric hospitalization - not the dull edge of this midlevel's clinical judgment.