When do you consider starting an antidepressant without a mood stabilizer in a patient with a historical diagnosis of bipolar II disorder who has not had hypomanic episodes in many years?  

What factors guide your assessment of the risk for antidepressant-induced hypomania for mood destabilization? Which antidepressants do you find safest or most effective for monotherapy in bipolar II depression? How do you counsel patients about potential risks and early warning signs of mood elevation, and what monitoring strategies (e.g., mood charting, early follow-up, collateral input) do you use to ensure stability?