Question

A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colourful clothes, increased talking. What is the next step in management ?

• A. Antipsychotic with Imipramine continued
• B. Discontinue Imipramine and start Valproate
• C. Continue Imipramine alone
• D. Manage with Valproate alone

Answer 1

The Correct Option is A

In this case, the patient originally presenting with depression has been on Imipramine for two weeks and is now showing signs such as increased excitement, wearing colorful clothes, and increased talking. This suggests a possible manic or hypomanic episode, indicating a switch from depression to mania.

The likely diagnosis here is a switch to a manic episode, potentially precipitated by the use of a tricyclic antidepressant such as Imipramine. This suggests the presence of Bipolar Disorder, characterized by episodes of depression and mania.

Management of this condition requires addressing the manic symptoms while continuing to treat depression. Therefore, the next step in management is:

• Continue the use of Imipramine to manage the depressive symptoms
• Introduce an antipsychotic to manage the manic symptoms

This therapeutic approach balances between treating both manic and depressive phases effectively within the context of Bipolar Disorder.