A 45-year-old woman with a known diagnosis of bipolar I disorder, currently maintained on lithium 900 mg/day, presents for routine follow-up. Her serum lithium level is 0.7 mEq/L. She reports a new episode of depressed mood, hopelessness, and suicidal ideation without any hypomanic or manic symptoms for the past 3 weeks. Which pharmacological addition is FDA-approved specifically for bipolar depression?
- A Sertraline
- B Olanzapine-fluoxetine combination ✓
- C Carbamazepine
- D Aripiprazole
Correct answer: B. Olanzapine-fluoxetine combination
Explanation
The olanzapine-fluoxetine combination (OFC, marketed as Symbyax) was the first FDA-approved treatment for bipolar depression. Quetiapine and lurasidone are also FDA-approved for bipolar depression. Standard antidepressants like sertraline are generally avoided as monotherapy in bipolar depression due to risk of precipitating mania or rapid cycling. Aripiprazole is approved for acute mania and as maintenance, but not for bipolar depression.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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