Questions: Scenario: A patient with bipolar I disorder presents with a severe depressive episode. Question: According to APA guidelines, what is a first-line treatment? Lithium. Antidepressant monotherapy. Valproate. Atypical antipsychotic.

The answer is Lithium.

Lithium is considered a first-line treatment for bipolar disorder, including severe depressive episodes in bipolar I disorder. It has been extensively studied and is recognized for its mood-stabilizing properties, helping to reduce the frequency and severity of both manic and depressive episodes.

Antidepressant monotherapy is generally not recommended as a first-line treatment for bipolar depression because it can potentially trigger manic episodes or rapid cycling in individuals with bipolar disorder.

Valproate is another mood stabilizer that is used in the treatment of bipolar disorder, particularly for manic episodes. However, it is not typically the first choice for treating severe depressive episodes in bipolar I disorder.

Atypical antipsychotics can be used in the treatment of bipolar disorder, including depressive episodes, but they are often considered after mood stabilizers like lithium. Some atypical antipsychotics have been approved for bipolar depression, but lithium remains a primary option.