Justin is a 23 year old male who is being managed for an acute manic episode. Justin was diagnosed with bipolar

disorder several years ago,but his home life has been unstable and he has not been very adherent to a medication regimen. most recently he was started on the SNRI venlafaxine by his primary care provider,which he has been taking as prescribed for about 6 wks,but he began a manic episode a few days ago peaked this evening, the AGACNP considers that:

1) the manic episode is probably a result of medication instability and he should continue his current regimen with a follow up in 6-8 wks

2) a mood stabilizing agent should be added to the venlafaxine

3) all medication should be held for 6-8 wks and the then the patient should be reevaluate

4) the SNRI should be stopped and a mood stabilizing agent started