Fast Five Quiz: Bipolar Disorder With Agitation

W. Clay Jackson, MD, DipTh


November 16, 2021

In 2013, the International Society for Bipolar Disorders (ISBD) Task Force reached a consensus that non-antidepressant treatments, including lithium, lamotrigine, olanzapine, quetiapine, and lurasidone, should be considered as monotherapy before using antidepressants in bipolar depression. If antidepressants are used in bipolar I disorder, they should be prescribed along with a mood-stabilizing treatment. No antidepressant is approved for bipolar disorder as monotherapy.

The ISBD also recommends that patients with bipolar disorder starting antidepressants as part of a bipolar treatment regimen should be closely monitored for signs of hypomania or mania and increased psychomotor agitation, in which case the antidepressant should be discontinued. Adjunctive treatment with serotonin-norepinephrine reuptake inhibitors or tricyclics and tetracyclics should be considered only after other antidepressants have been tried, and patients should be closely monitored because of an increased risk for mood switch or destabilization.

 Learn more about bipolar disorder treatments.

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