American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.
F Benazzi . Reviewing the diagnostic validity and utility of mixed depression (depressive mixed states). Eur Psychiatry. 2008; 23(1): 40–48; Epub ahead of print Aug 30, 2007.
J Hu , R Mansur , RS McIntyre . Mixed specifier for bipolar mania and depression: highlights of DSM–5 changes and implications for diagnosis and treatment in primary care. Prim Care Companion CNS Disord. 2014; 16(2): pii: PCC.13r01599. Epub ahead of print Apr 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116292/. Accessed January 29, 2017.
T Sato , R Bottlender , M Sievers , A Schröter , N Kleindienst , HJ Möller . Evaluating the inter-episode stability of depressive mixed states. J Affect Disord. 2004; 81(2): 103–113.
E Solé , M Garriga , M Valentí , E Vieta . Mixed features in bipolar disorder. CNS Spectr. 2017: 1–7; Epub ahead of print.
MA Cerullo , SM Strakowski . A systematic review of the evidence for the treatment of acute depression in bipolar I disorder. CNS Spectr. 2013; 18(4): 199–208; Epub ahead of print Mar 18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3688656/. Accessed January 29, 2017.
A Cleare , CM Pariante , AH Young , et al. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol. 2015. 29(5): 459–525; Epub ahead of print May 12. http://journals.sagepub.com/doi/pdf/10.1177/0269881115581093. Accessed January 29, 2017.
Goodwin GM, Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for treating bipolar disorder: revised second edition. Recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2009; 23(4): 346–388; Epub ahead of print Mar 27. http://journals.sagepub.com/doi/pdf/10.1177/0269881109102919. Accessed January 29, 2017.
H Grunze , E Vieta , GM Goodwin , et al. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: update 2010 on the treatment of acute bipolar depression. World J Biol Psychiatry. 2010; 11(2): 81–109.
RS McIntyre , J Yoon . Efficacy of antimanic treatments in mixed states. Bipolar Disord. 2012; 14(Suppl. 2): 22–36.
L Musetti , C Del Grande , D Marazziti , L Dell’Osso . Treatment of bipolar depression. CNS Spectr. 2013; 18(4): 177–187; Epub ahead of print Feb 8.
AM Nivoli , A Murru , JM Goikolea , et al. New treatment guidelines for acute bipolar mania: a critical review. J Affect Disord. 2012; 140(2): 125–141; Epub ahead of print Nov 17, 2011.
LN Yatham , SH Kennedy , SV Parikh , et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013; 15(1): 1–44; Epub ahead of print Dec 12, 2012.
LN Yatham , SH Kennedy , A Schaffer , et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord. 2009; 11(3): 225–255.
KN Fountoulakis , H Grunze , E Vieta , et al. The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP–BD–2017), part 3: the clinical guidelines. Int J Neuropsychopharmacol. 2016: pii: pyw109. Epub ahead of print. https://academic.oup.com/ijnp/article-lookup/doi/10.1093/ijnp/pyw109. Accessed January 29, 2017.
H Grunze , JM Azorin . Clinical decision making in the treatment of mixed states. World J Biol Psychiatry. 2014; 15(5): 355–368; Epub ahead of print May 14.
M Takeshima , T Oka . DSM–5-defined “mixed features” and Benazzi’s mixed depression: which is practically useful to discriminate bipolar disorder from unipolar depression in patients with depression?
Psychiatry Clin Neurosci. 2015; 69(2): 109–116; Epub ahead of print Jul 14, 2014. http://onlinelibrary.wiley.com/doi/10.1111/pcn.12213/full. Accessed January 29, 2017.
A Koukopoulos , G Sani . DSM–5 criteria for depression with mixed features: a farewell to mixed depression. Acta Psychiatr Scand. 2014; 129(1): 4–16; Epub ahead of print Apr 19, 2013.
GS Malhi , L Lampe , CM Coulston , et al. Mixed state discrimination: a DSM problem that wont go away?
J Affect Disord. 2014; 158: 8–10; Epub ahead of print Jan 28.
F Benazzi , HS Akiskal . Psychometric delineation of the most discriminant symptoms of depressive mixed states. Psychiatry Res. 2006; 141(1): 81–88; Epub ahead of print Nov 28, 2005.
GL Faedda , C Marangoni , D Reginaldi . Depressive mixed states: a reappraisal of Koukopoulos’ criteria. J Affect Disord. 2015; 176: 18–23; Epub ahead of print Feb 4.
P Olgiati , A Serretti , C Colombo . Retrospective analysis of psychomotor agitation, hypomanic symptoms, and suicidal ideation in unipolar depression. Depress Anxiety. 2006; 23(7): 389–397.
G Perugi , J Angst , JM Azorin , et al. Mixed features in patients with a major depressive episode: the BRIDGE–II–MIX study. J Clin Psychiatry. 2015; 76(3): e351–e358.
G Sani , F Napoletano , PA Vohringer , et al. Mixed depression: clinical features and predictors of its onset associated with antidepressant use.
Psychother Psychosom.. 2014; 83(4): 213–221; Epub ahead of print Jun 19.
G Sani , PA Vohringer , F Napoletano , et al. Koukopoulos’ diagnostic criteria for mixed depression: a validation study. J Affect Disord. 2014; 164: 14–18; Epub ahead of print Apr 12.
ML Prieto , EA Youngstrom , A Ozerdem , et al. Different patterns of manic/hypomanic symptoms in depression: a pilot modification of the Hypomania Checklist–32 to assess mixed depression. J Affect Disord. 2015; 172: 355–360.
D Axelson , B Goldstein , T Goldstein , et al. Diagnostic precursors to bipolar disorder in offspring of parents with bipolar disorder: a longitudinal study. Am J Psychiatry. 2015; 172(7): 638–646; Epub ahead of print Mar 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489996/. Accessed January 30, 2017.
HS Akiskal , F Benazzi . Family history validation of the bipolar nature of depressive mixed states. J Affect Disord. 2003; 73(1–2): 113–122.
E Brietzke , CLRL Moreira , SVB Duarte , et al. Impact of comorbid migraine on the clinical course of bipolar disorder. Compr Psychiatry. 2012; 53(6): 809–812; Epub ahead of print Nov 20, 2011.
KJ Oedegaard , OB Fasmer . Is migraine in unipolar depressed patients a bipolar spectrum trait?
J Affect Disord. 2005; 84(2–3): 233–242.
A Ortiz , P Cervantes , G Zlotnik , et al. Cross-prevalence of migraine and bipolar disorder. Bipolar Disord. 2010; 12(4): 397–403.
D Dudek , M Siwek , D Zielinska , R Jaeschke , J Rybakowski . Diagnostic conversions from major depressive disorder into bipolar disorder in an outpatient setting: results of a retrospective chart review. J Affect Disord. 2013; 144(1–2): 112–115; Epub ahead of print Aug 5, 2012.
V Sharma , M Khan , A Smith . A closer look at treatment-resistant depression: is it due to a bipolar diathesis?
J Affect Disord. 2005; 84(2–3): 251–257.
JD Amsterdam , J Shults . Does tachyphylaxis occur after repeated antidepressant exposure in patients with bipolar II major depressive episode?
J Affect Disord. 2009; 115(1–2): 234–240; Epub ahead of print Aug 9, 2008.
RM Post , GS Leverich , LL Altshuler , et al. Relationship of prior antidepressant exposure to long-term prospective outcome in bipolar I disorder outpatients. J Clin Psychiatry. 2012; 73(7): 924–930; Epub ahead of print Mar 20.
JF Goldberg , JL Garno , AM Callahan , DL Kearns , B Kerner , SH Ackerman . Overdiagnosis of bipolar disorder among substance use disorder inpatients with mood instability. J Clin Psychiatry. 2008; 69(11): 1751–1757; Epub ahead of print Aug 12, 2008.
F Galvao , S Sportiche , J Lambert , et al. Clinical differences between unipolar and bipolar depression: interest of BDRS (Bipolar Depression Rating Scale). Compr Psychiatry. 2013; 54(6): 605–610; Epub ahead of print Jan 31.
JB Williams , M Terman , MJ Link , L Amira , NE Rosenthal . Hypomania interview guide (including hyperthymia): retrospective assessment version (HIGH–R). Depress Anxiety. 1999; 9(2): 92–100.
F Benazzi . Depressive mixed state: dimensional versus categorical definitions. Prog Neuropsychopharmacol Biol Psychiatry. 2003; 27(1): 129–134.
T Hergueta , E Weiller . Evaluating depressive symptoms in hypomanic and manic episodes using a structured diagnostic tool: validation of a new Mini International Neuropsychiatric Interview (M.I.N.I.) module for the DSM–5 “With Mixed Features” specifier. Int J Bipolar Disord. 2013; 1: 21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230688/. Accessed January 30, 2017.
M Zimmerman , I Chelminski , D Young , K Dalrymple , JH Martinez . A clinically useful self-report measure of the DSM–5 mixed features specifier of major depressive disorder. J Affect Disord. 2014; 168: 357–362; Epub ahead of print Jul 22.
K Altinbas , A Ozerdem , ML Prieto , et al. A multinational study to pilot the modified Hypomania Checklist (mHCL) in the assessment of mixed depression. J Affect Disord. 2014; 152–154: 478–482.
EG Altman , D Hedeker , JL Peterson , JM Davis . The Altman Self-Rating Mania Scale. Biol Psychiatry. 1997; 42(10): 948–955.
HS Akiskal , F Benazzi , G Perugi , Z Rihmer . Agitated “unipolar” depression re-conceptualized as a depressive mixed state: implications for the antidepressant–suicide controversy. J Affect Disord. 2005; 85(3): 245–258.
HS Akiskal , F Benazzi . Psychopathologic correlates of suicidal ideation in major depressive outpatients: is it all due to unrecognized (bipolar) depressive mixed states?
Psychopathology. 2005; 38(5): 273–280.
J Balazs , F Benazzi , Z Rihmer , A Rihmer , KK Akiskal , HS Akiskal . The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention. J Affect Disord. 2006; 91(2–3): 133–138; Epub ahead of print Feb 3.
F Benazzi . Bipolar disorder: focus on bipolar II disorder and mixed depression. Lancet. 2007; 369(9565): 935–945.
L Bjorklund , HT Horsdal , O Mors , SD Ostergaard , C Gasse . Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study. Acta Neuropsychiatr. 2016; 28(2): 75–84; Epub ahead of print Sep 11, 2015.
HJ Gijsman , JR Geddes , JM Rendell , WA Nolen , GM Goodwin . Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry. 2004; 161(9): 1537–1547; https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0021171/. Accessed January 30, 2017.
HJ Möller , H Grunze , K Broich . Do recent efficacy data on the drug treatment of acute bipolar depression support the position that drugs other than antidepressants are the treatment of choice? A conceptual review. Eur Arch Psychiatry Clin Neurosci. 2006; 256(1): 1–16; Epub ahead of print Aug 4, 2005.
AA Nierenberg . An analysis of the efficacy of treatments for bipolar depression. J Clin Psychiatry. 2008; 69(Suppl. 5): 4–8.
I Pacchiarotti , DJ Bond , RJ Baldessarini , et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry. 2013; 170(11): 1249–1262; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091043/. Accessed January 30, 2017.
CU Pae , PA Vohringer , NS Holtzman , et al. Mixed depression: a study of its phenomenology and relation to treatment response. J Affect Disord. 2012; 136(3): 1059–1061; Epub ahead of print Dec 14, 2011.
Z Rihmer , H Akiskal . Do antidepressants t(h)reat(en) depressives? Toward a clinically judicious formulation of the antidepressant–suicidality FDA advisory in light of declining national suicide statistics from many countries. J Affect Disord. 2006; 94(1–3): 3–13; Epub ahead of print May 19.
KN Fountoulakis , S Kasper , O Andreassen , et al. Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci. 2012; 262(Suppl 1.): 1–48.
MM Sidor , GM Macqueen . Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis. J Clin Psychiatry. 2011; 72(2): 156–167; Epub ahead of print Oct 5, 2010. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0031744/. Accessed January 30, 2017.
A Tundo , JR Calabrese , L Proietti , R de Filippis . Short-term antidepressant treatment of bipolar depression: are ISBD recommendations useful in clinical practice?
J Affect Disord. 2015; 171: 155–160; Epub ahead of print Sep 28, 2014.
H Grunze . The role of polypharmacy in bipolar disorder treatment guidelines. In: Ritsner MS, ed. Polypharmacy in Psychiatry Practice Vol. II: Use of Polypharmacy in the “Real World.” New York: Springer Science; 2013: P. 275–287.
WT Heijnen , J De Fruyt , AI Wierdsma , P Sienaert , TK Birkenhager . Efficacy of tranylcypromine in bipolar depression: a systematic review. J Clin Psychopharmacol. 2015; 35(6): 700–705.
RS McIntyre , M Tohen , M Berk , J Zhao , E Weiller . DSM–5 mixed specifier for manic episodes: evaluating the effect of depressive features on severity and treatment outcome using asenapine clinical trial data. J Affect Disord. 2013; 150(2): 378–383; Epub ahead of print May 25.
RS McIntyre , J Cucchiaro , A Pikalov , H Kroger , A Loebel . Lurasidone in the treatment of bipolar depression with mixed (subsyndromal hypomanic) features: post hoc analysis of a randomized placebo-controlled trial. J Clin Psychiatry. 2015; 76(4): 398–405; http://www.psychiatrist.com/jcp/article/Pages/2015/v76n04/v76n0402.aspx. Accessed January 30, 2017.
T Suppes , R Silva , J Cucchiaro , et al. Lurasidone for the treatment of major depressive disorder with mixed features: a randomized, double-blind, placebo-controlled study. Am J Psychiatry. 2016; 173(4): 400–407; Epub ahead of print Nov 10, 2015.
M Tohen , S Kanba , RS McIntyre , S Fujikoshi , H Katagiri . Efficacy of olanzapine monotherapy in the treatment of bipolar depression with mixed features. J Affect Disord. 2014; 164: 57–62; Epub ahead of print Jul 3.
T Suppes , TA Ketter , IS Gwizdowski , et al. First controlled treatment trial of bipolar II hypomania with mixed symptoms: quetiapine versus placebo. J Affect Disord. 2013; 150(1): 37–43; Epub ahead of print Mar 19.
A Patkar , W Gilmer , CU Pae , et al. A 6-week randomized double-blind placebo-controlled trial of ziprasidone for the acute depressive mixed state. PLoS One. 2012; 7(4): e34757. Epub ahead of print Apr 24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335844/. Accessed January 30, 2017.
I Lombardo , G Sachs , S Kolluri , C Kremer , R Yang . Two 6-week, randomized, double-blind, placebo-controlled studies of ziprasidone in outpatients with bipolar I depression: did baseline characteristics impact trial outcome?
J Clin Psychopharmacol. 2012; 32(4): 470–478.
M Takeshima . Treating mixed mania/hypomania: a review and synthesis of the evidence. CNS Spectr. 2016: 1–9; Epub ahead of print.
T Kelly , DZ Lieberman . The utility of low-dose aripiprazole for the treatment of bipolar II and bipolar NOS depression. J Clin Psychopharmacol. 2017; 37(1): 99–101.
SM Stahl . Prescriber’s Guide: Stahl’s Essential Psychopharmacology, 5th ed. New York: Cambridge University Press; 2014.
AC Swann , CL Bowden , D Morris , et al. Depression during mania: treatment response to lithium or divalproex. Arch Gen Psychiatry. 1997; 54(1): 37–42.
S Magiria . Evidence-based combination therapy for bipolar disorder. In: Ritsner MS, ed. Polypharmacy in Psychiatry Practice Vol. II: Use of Polypharmacy in the “Real World.”
New York, NY: Springer Science; 2013: P. 159–177.
RS Ei-Mallakh , A Karippot . Antidepressant-associated chronic irritable dysphoria (acid) in bipolar disorder: a case series. J Affect Disord. 2005; 84(2–3): 267–272.
LL Altshuler , RM Post , G Hellemann , et al. Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression: a blinded, randomized study. J Clin Psychiatry. 2009; 70(4): 450–457; Epub ahead of print Apr 7.
M Bauer , S Berman , T Stamm , et al. Levothyroxine effects on depressive symptoms and limbic glucose metabolism in bipolar disorder: a randomized, placebo-controlled positron emission tomography study. Mol Psychiatry. 2016; 21(2): 229–236; Epub ahead of print Jan 20, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790155/. Accessed January 30, 2017.
TJ Stamm , U Lewitzka , C Sauer , et al. Supraphysiologic doses of levothyroxine as adjunctive therapy in bipolar depression: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2014; 75(2): 162–168.
BS Fernandes , OM Dean , S Dodd , GS Malhi , M Berk . N-acetylcysteine in depressive symptoms and functionality: a systematic review and meta-analysis. J Clin Psychiatry. 2016; 77(4): e457–e466.
M Berk , O Dean , SM Cotton , et al. The efficacy of N-acetylcysteine as an adjunctive treatment in bipolar depression: an open label trial. J Affect Disord. 2011; 135(1–3): 389–394; Epub ahead of print Jun 29.
J Sarris , D Mischoulon , I Schweitzer . Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. J Clin Psychiatry. 2012; 73(1): 81–86; Epub ahead of print Aug 9, 2011.
PA Geoffroy , B Etain , JA Franchi , F Bellivier , P Ritter . Melatonin and melatonin agonists as adjunctive treatments in bipolar disorders. Curr Pharm Des. 2015; 21(23): 3352–3358.
F Faridhosseini , R Sadeghi , L Farid , M Pourgholami . Celecoxib: a new augmentation strategy for depressive mood episodes. A systematic review and meta-analysis of randomized placebo-controlled trials. Hum Psychopharmacol. 2014; 29(3): 216–223; Epub ahead of print Mar 16.
SA Corp , MJ Gitlin , LL Altshuler . A review of the use of stimulants and stimulant alternatives in treating bipolar depression and major depressive disorder. J Clin Psychiatry. 2014; 75(9): 1010–1018.
AJ Goss , M Kaser , SG Costafreda , BJ Sahakian , CH Fu . Modafinil augmentation therapy in unipolar and bipolar depression: a systematic review and meta-analysis of randomized controlled trials. J Clin Psychiatry. 2013; 74(11): 1101–1107; https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0061792/. Accessed January 30, 2017.
MJ Taylor , H Wilder , Z Bhagwagar , J Geddes . Inositol for depressive disorders. Cochrane Database Syst Rev. 2004; 2: CD004049.
T Mukai , T Kishi , Y Matsuda , N Iwata . A meta-analysis of inositol for depression and anxiety disorders. Hum Psychopharmacol. 2014; 29(1): 55–63; Epub ahead of print Dec 3, 2013.
C Kraus , U Rabl , T Vanicek , et al. Administration of ketamine for unipolar and bipolar depression. Int J Psychiatry Clin Pract. 2017: 1–12; Epub ahead of print.
B Dell’Osso , TA Ketter . Assessing efficacy/effectiveness and safety/tolerability profiles of adjunctive pramipexole in bipolar depression: acute versus long-term data. Int Clin Psychopharmacol. 2013; 28(6): 297–304.
SC Dilsaver , F Benazzi , HS Akiskal . Mixed states: the most common outpatient presentation of bipolar depressed adolescents?
Psychopathology. 2005; 38(5): 268–272; Epub ahead of print Sep 21.
SC Dilsaver , F Benazzi , Z Rihmer , KK Akiskal , HS Akiskal . Gender, suicidality and bipolar mixed states in adolescents. J Affect Disord. 2005; 87(1): 11–16.
MK Singh , T Ketter , KD Chang . Distinguishing bipolar disorder from other psychiatric disorders in children. Curr Psychiatry Rep. 2014; 16(12): 516.
A Cipriani , X Zhou , C Del Giovane , et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet. 2016; 388(10047): 881–890; Epub ahead of print Jun 8.
LS Cohen , B Wang , R Nonacs , AC Viguera , EL Lemon , MP Freeman . Treatment of mood disorders during pregnancy and postpartum. Psychiatr Clin North Am. 2010; 33(2): 273–293.