Which antidepressant is ABSOLUTELY CONTRAINDICATED in bipolar depression due to high risk of inducing mania/rapid cycling when used as monotherapy without a mood stabilizer?
- A Quetiapine
- B Tricyclic antidepressants (e.g., amitriptyline) ✓
- C Lamotrigine
- D Lithium
Correct answer: B. Tricyclic antidepressants (e.g., amitriptyline)
Explanation
Tricyclic antidepressants (TCAs) carry the highest risk of inducing manic switch and rapid cycling in bipolar disorder when used as monotherapy. They should be avoided in bipolar depression. Quetiapine monotherapy and lamotrigine are FDA-approved/evidence-based treatments for bipolar depression with mood-stabilizing properties. Lithium is a mood stabilizer and can be used in bipolar depression. If antidepressants are used at all in bipolar depression, they must be combined with a mood stabilizer and SSRIs are preferred over TCAs.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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