A bipolar patient with acute depressive relapse after stopping medications should be treated with which of the following?

• A. Restart bipolar medications such as lithium, lamotrigine, quetiapine, and lurasidone
• B. Restart SSRIs alone
• C. Start benzodiazepines alone
• D. Start lithium only

Answer: (A)

In bipolar disorder, when someone relapses into acute depression after stopping meds, the priority is to reestablish mood stabilization with agents proven to treat bipolar depression, rather than using antidepressants alone. Restarting bipolar medications such as lithium, lamotrigine, or atypical antipsychotics like quetiapine or lurasidone provides stabilization across mood poles and reduces the risk of relapse and mania. Lithium has a long track record and also lowers suicide risk; lamotrigine is particularly effective for bipolar depression; quetiapine and lurasidone have solid data supporting their use in bipolar depression as well.

Using an antidepressant by itself is not ideal in bipolar disorder because it can trigger mania or rapid cycling if not paired with a mood stabilizer. Benzodiazepines might help with anxiety or sleep in the short term but do not treat the underlying mood disorder. Starting lithium only would be insufficient to address the depressive relapse comprehensively, since the other mood-stabilizing options also provide proven benefit in bipolar depression.