Psychiatrymiddle twist
A 29-year-old man with bipolar I disorder is reviewed in the community mental health clinic. He was admitted at 22 with a manic episode and stopped lithium three years ago because of tremor. For six weeks he has had low mood, hypersomnia, poor concentration and no interest in anything. There are no psychotic features, he has no thoughts of self-harm, and he is not using alcohol or other drugs. He has read about his condition, will accept one medicine but has been clear that he will not take two. Which one of the following drug treatments is best supported by evidence for his current episode?