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Bipolar depression management — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Bipolar depression managementUSMLE Step 3

A 29-year-old woman with bipolar I disorder has 6 weeks of depressed mood, hypersomnia, and low energy. She has no psychosis or suicidal plan. She stopped lithium 3 months ago. She asks for an antidepressant because it helped a friend. Which of the following is the most appropriate next step in management?

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Reveal the answer and explanation

Correct answer: A — Restart mood stabilizer therapy before considering antidepressants

Antidepressant monotherapy can precipitate mania in bipolar I disorder; mood stabilizer or approved bipolar depression treatment is preferred.

Reference: APA Bipolar Disorder Practice Guideline