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?

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 ...

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...