A 38-yrs-old woman with bipolar disorder has been stable on lithium for the past 2 years. She comes to her psychiatrist's office in tears after a 2week history of a depressed mood, poor concentration, loss of appetite, and passive suicidal ideation. Which of the following steps should the psychiatrist take next?
Since lithium and other mood stabilizers are more effective in the prevention of manic episodes than in the prevention of depression, antidepressants are used as an adjunctive treatment when depressive episodes develop during maintenance with a mood stabilizer. Since the incidence of antidepressant-induced mania is high (up to 30%), and since antidepressant treatment may cause rapid cycling, the antidepressant should be tapered and discontinued as soon as the depressive symptoms remit. Among the antidepressants in common use, buproprion is considered to carry a slightly lower risk of triggering mania.
Start the patient on a second mood stabilizer
Start the patient on a long-acting benzodiazepine
Stop the lithium and start an antidepressant
Start an antidepressant and continue the lithium