Managing individuals at risk for developing bipolar disorder (BD), particularly those with latent BD, poses significant clinical challenges. This chapter reviews the limited literature on pharmacological strategies for latent BD, emphasizing the need for early identification and careful implementation of psychosocial and pharmacological interventions. Key dilemmas include the risks of initiating treatment with antidepressants versus mood stabilizers or atypical antipsychotics. It evaluates treatment options, highlighting the cautious use of antidepressants in select cases and the potential roles of mood stabilizers and atypical antipsychotics in managing depressive and hypomanic symptoms. Ultimately, an individualized approach is recommended, stressing the importance of careful monitoring and ongoing research to develop evidence-based strategies for managing latent BD.