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?
2 Answers
Mednet MemberInvited Expert
Psychiatry · Massachusetts General Hospital / Harvard Medical School
Answered on
I happen to have a patient just like this now on my inpatient service. One of the problems we run into often is uncertainty around the validity of the bipolar spectrum in the first place. We see so much complicated trauma, maladaptive behaviors, and disordered personality structures that periods of ...
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Mednet MemberInvited Expert
Psychiatry · Christiana Psychiatric Services
Answered on
Firstly, it is important to ascertain whether that historical diagnosis was accurate. If so, I would tread very carefully in prescribing an unopposed antidepressant. Patient and physician must be vigilant, if one is prescribed, for any indication of manic switch.
It may be prudent to try a mood stab...
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