Which agent is listed for depressive episodes in bipolar disorder?

• A. Lamotrigine
• B. Lithium
• C. Clozapine
• D. Quetiapine

Answer: (D)

Depressive episodes in bipolar disorder are best treated with medications that have strong, proven efficacy for bipolar depression. Quetiapine fits this need because it has robust evidence and is approved for bipolar depression, including acute depressive symptoms. It works as an atypical antipsychotic with effects on multiple neurotransmitter systems, helping reduce core depressive symptoms and often improving sleep and energy as well. It can be used as monotherapy or with other agents, making it a versatile option for managing depressive episodes.

Lamotrigine is excellent for preventing depressive relapses (maintenance therapy) and has a role in bipolar depression, but its effectiveness in treating an acute depressive episode is more limited. Lithium is superb for mania and long-term stabilization and suicidality risk reduction, but it’s not as reliable for acute bipolar depression. Clozapine is not indicated for bipolar depression and is reserved for treatment-resistant schizophrenia.