The correct answer is D. This patient has a history of at least one major depressive episode and at least one hypomanic episode without the presence of mixed or manic episodes, a history consistent with bipolar II disorder. Treatment for this disorder is a mood stabilizer, most commonly lithium. A common adverse effect of this therapy is nephrogenic diabetes insipidus, in which the principal cells of the renal collecting duct are unable to respond to ADH secreted by the posterior pituitary. As a result, the patient will be unable to concentrate urine and will thus experience frequent urination.
Answer A is incorrect. Agranulocytosis is a toxicity associated with clozapine, an atypical antipsychotic. This medication is generally used in treatment of schizophrenia, but may be used in cases of mania that are unresponsive to first-line drugs such as lithium. Although the patient did have a history of a hypomanic episode, there is no indication for clozapine as a first-line treatment for bipolar II disorder.
Answer B is incorrect. Anorgasmia is a common adverse effect of selective serotonin reuptake inhibitors. This class of medication, which includes fluoxetine, paroxetine, sertraline, and citalopram, is commonly used in the treatment of major depression. Although this patient has a history of feeling depressed, she also has a history notable for a hypomanic episode. A major depressive episode is diagnosed if the patient has 5/9 symptoms for at least two weeks, including Sleep changes, loss of Interest (anhedonia), Guilt, Energy loss, Concentration changes, Appetite changes, Psychomotor abnormalities, and Suicidal thoughts (SIG E CAPS). One of the symptoms has to be depressed mood or anhedonia. Major depressive disorder is diagnosed after a major depressive episode without a history of mania, hypomania, or mixed episodes (when criteria for both manic and major depressive episode are simultaneously present for at least one week), and is further specified by modifiers such as recurrent, chronic, or postpartum onset.
Answer C is incorrect. Arrhythmias are a well-known adverse effect of the tricyclic antidepressants. This class of medications, which includes imipramine, clomipramine, and amitriptyline, work to block the reuptake of norepinephrine and serotonin. They are commonly used medications in the treatment of major depression, obsessive compulsive disorder, and fibromyalgia. However, the patient in this case has a clinical history most consistent with bipolar II disorder, and thus a mood stabilizer such as lithium should be used rather than an antidepressant, which could lead to further manic episodes in this patient.
Answer E is incorrect. Stevens-Johnson syndrome is a well-known adverse effect of carbamazepine, an anti-epileptic drug that is sometimes used to treat bipolar disorder. Although this patient has a medical history consistent with bipolar II disorder, first-line treatment is generally with a different mood stabilizer such as lithium, as this medication has been proven effective, is cheaper, and has a relatively less severe adverse-effect profile.