Which of the following antidepressants is most associated with switch to mania in bipolar disorder and should generally be AVOIDED as monotherapy?

• A Lamotrigine
• B Quetiapine
• C Lithium
• D Venlafaxine (SNRI) ✓

Explanation

Among antidepressant classes, SNRIs (particularly venlafaxine) and tricyclic antidepressants carry the highest risk of inducing manic switch or rapid cycling in bipolar disorder. SSRIs have intermediate switch risk. Bupropion and MAOIs also carry switch risk. Lamotrigine is a mood stabiliser (approved for bipolar I depression maintenance), quetiapine is an atypical antipsychotic approved for bipolar depression, and lithium is the gold-standard mood stabiliser — all three are used in bipolar disorder rather than avoided. SNRIs should be used with great caution, and only with a mood stabiliser cover, in bipolar depression.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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