The patient is suffering from bipolar depression. The American Psychiatric Association recommends that for a patient with a breakthrough depressive episode who is currently taking a mood stabilizer, the first step is to optimize the dose and blood level of maintenance medications. Checking the lithium level must be done first, followed by dose optimization. Discontinuing lithium is not appropriate, and increasing the lithium dosage without first checking the level could result in toxicity. Initiation of antidepressant therapy with either a SSRI or bupropion should not be considered unless optimization of lithium therapy fails because either can induce mania.
- Check the lithium level.
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