Which medication class must be used cautiously and never as monotherapy in clients with bipolar disorder?

The medication class that requires cautious use and should never be used as monotherapy in clients with bipolar disorder is antidepressants. In bipolar disorder, the primary concern with antidepressants is the potential to induce manic or hypomanic episodes when administered without a mood stabilizer. Patients diagnosed with bipolar disorder typically experience fluctuations in mood that can include swings from depressive states to manic states. When antidepressants are used alone in this population, they may inadvertently exacerbate the manic phase, leading to worsening of the overall illness.

Additionally, the use of antidepressants can be particularly risky in individuals who are currently experiencing a depressive episode without adequate mood stabilization, making the inclusion of a mood stabilizer essential in treatment. Mood stabilizers, such as lithium or certain anticonvulsants, are typically the preferred first-line treatment options for managing bipolar disorder, given their efficacy in preventing mood shifts.

Other classes of medications mentioned, such as antipsychotics, may be employed in treating acute mania or mixed episodes and are often used in combination with mood stabilizers. Stimulants can be used cautiously, particularly in cases of comorbid ADHD, while long-acting benzodiazepines are generally used for anxiety management and are not a primary treatment for the mood episodes of