A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. Which drug should the nurse anticipate will be prescribed?

Choice A reason: Persistent depressive disorder responds better to SSRIs or psychotherapy, as MAOIs’ risk of hypertensive crises due to monoamine buildup limits their use. MAOIs increase serotonin, dopamine, and norepinephrine, but are reserved for severe cases due to complex neural interactions.

Choice B reason: MAOIs like phenelzine are used for treatment-resistant depression, where SSRIs fail, by increasing serotonin, dopamine, and norepinephrine via enzyme inhibition. This broad monoamine enhancement alters prefrontal-amygdala circuits, addressing severe depressive symptoms unresponsive to other treatments, making it the primary indication.

Choice C reason: Moderate depression is typically treated with SSRIs or SNRIs, which have safer profiles. MAOIs’ risk of serotonin and norepinephrine overload, causing hypertensive crises, makes them unsuitable for moderate cases, where less aggressive neural modulation is effective.

Choice D reason: Mild depression is managed with psychotherapy or SSRIs, not MAOIs, which risk serious side effects like tyramine-induced hypertensive crises due to excessive monoamine levels. MAOIs are reserved for severe, resistant cases, not mild neural dysregulation.

Choice A reason: Divorce represents distress, not eustress, as it triggers negative emotional responses via heightened cortisol and amygdala activity, disrupting serotonin and dopamine balance. This chronic stress impairs prefrontal cortex function, leading to emotional dysregulation, unlike eustress, which promotes positive motivation and growth.

Choice B reason: Job loss threat is distress, activating the HPA axis to release cortisol, increasing amygdala-driven anxiety. This disrupts serotonin signaling, impairing mood regulation, and does not foster positive motivation or growth, unlike eustress, which involves beneficial stress enhancing performance without overwhelming neural systems.

Choice C reason: Financial strain is distress, elevating cortisol via HPA axis activation, increasing amygdala activity, and reducing prefrontal control, leading to anxiety. Unlike eustress, which promotes motivation through manageable challenges, this scenario causes negative emotional responses, disrupting serotonin and dopamine balance, impairing coping mechanisms.

Choice D reason: Learning new skills for a promotion is eustress, activating moderate HPA axis responses and dopamine release in the reward system, enhancing motivation and prefrontal cortex function. This positive stress promotes neuroplasticity, improving cognitive adaptability and emotional resilience, unlike distress, which overwhelms neural regulatory systems.