Pharmacotherapeutic Options for Bipolar Depression

A patient with a history of rapid-cycling bipolar disorder presents for evaluation of her current, profound depressive symptoms. The patient has been maintained for the last two years on valproic acid and quetiapine, but now a major depressive episode has occurred and the patient is reporting passive suicidal ideation. 

Concerned that the suicidal ideation may progress, the PMHNP consider which of the following pharmacotherapeutic options? 

A. Cariprazine 

B. Lumateperone 

C. Aripiprazole 

D. Lithium