Bipolar — Depression & Maintenance

Bipolar depression is the phase clients spend the most time in, yet it carries unique treatment constraints. The cornerstone difference: antidepressant monotherapy is contraindicated because it can trigger a manic switch or rapid cycling. Instead, mood stabilizers form the foundation. Lithium (therapeutic range 0.6–1.2 mEq/L for maintenance) is a key agent for both bipolar depression and long-term relapse prevention. Lamotrigine is particularly effective for preventing bipolar depressive episodes and is titrated slowly to avoid Stevens-Johnson syndrome. If an antidepressant is used at all, it must be paired with a mood stabilizer. Quetiapine (an atypical antipsychotic) is also FDA-approved for bipolar depression. Maintenance therapy is lifelong — discontinuation dramatically increases relapse risk. Nursing priorities during the depressive phase include monitoring for psychomotor retardation, social withdrawal, hypersomnia, hopelessness, and medication adherence. Clients often stop medications when they feel stable, so ongoing education about the chronic relapsing nature of bipolar disorder is essential. Lithium monitoring includes renal function, thyroid function, and hydration status, since dehydration and sodium depletion raise lithium levels toward toxicity.