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the expected effect size is small and the onset is slow - Avoid antidepressants in bipolar depression presenting with subtle increased psychomotor tempo, pressured speech and racing thoughts due to the increased risk of switch and potentially rapid cycling - Consider ETC as a viable option for the treatment of bipolar depression resistant to pharmacological treatment - Never treat with antidepressants without a mood stabiliser - If an antidepressant is added, use mainly SSRIs due to their low switch rate - If an antidepressant is used in maintenance treatment, the occurrence of manic/mixed symptoms should be monitored carefully The above recommendation is consistent with current Danish guidelines for the pharmacological treatment of bipolar disorder [42], which recommend lithium, quetiapine and lamotrigine as first-line agents for bipolar I disorder, current depressive episode, in at least 70% of patients, and for bipolar II disorder, current depressive episode, in at least 60%

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Thyroid C-cell Tumors: Studies in rodents have shown an increased risk of thyroid C-cell tumors, including medullary thyroid carcinoma (MTC)