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Bipolar depression — MCCQE Part 1 MCQ

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HardDepressionBipolar depressionMCCQE Part 1

26-year-old woman presents with depressive symptoms. She previously had 5 days of decreased sleep, increased energy and risky spending. Which of the following is the most appropriate next step?

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Correct answer: B — Avoid antidepressant monotherapy and assess/treat bipolar spectrum disorder

Avoid antidepressant monotherapy and assess/treat bipolar spectrum disorder is best because past hypomanic symptoms change management from unipolar depression. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Screen for mania before starting antidepressants.

Reference: CANMAT bipolar disorder guidelines