Skip to main content
×
×
Home

Mixed-up about how to diagnose and treat mixed features in major depressive episodes

  • Stephen M. Stahl
  • Please note a correction has been issued for this article.
Abstract

The classical point of view—that major depressive episodes (MDEs), no matter what additional symptoms are present, should be treated first line with antidepressants—is now giving way to new a notion. The idea is that MDEs mixed with a few symptoms of mania/hypomania should be viewed very differently in terms of their natural history, clinical outcome, and treatment, and perhaps certain antipsychotics should be given as first-line treatment rather than antidepressant monotherapy.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Mixed-up about how to diagnose and treat mixed features in major depressive episodes
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Mixed-up about how to diagnose and treat mixed features in major depressive episodes
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Mixed-up about how to diagnose and treat mixed features in major depressive episodes
      Available formats
      ×
Copyright
References
Hide All
1. Stahl, SM. Stahl’s Essential Psychopharmacology. 4th ed. New York: Cambridge University Press; 2014.
2. Stahl, SM, Morrissette, DA, Faedda, G, et al. Guidelines for the recognition and treatment of mixed depression. CNS Spectr.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text rev. Washington, DC: American Psychiatric Association; 2000.
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., Washington, DC: American Psychiatric Association; 2013.
5. Hu, J, Mansur, R, McIntyre, RS. 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): PCC.13r01599.
6. Koukopoulos, A, Sani, G. DSM-5 criteria for depression with mixed features: a farewell to mixed depression. Acta Psychiatr Scand. 2014; 129(1): 416.
7. Benazzi, F. Reviewing the diagnostic validity and utility of mixed depression (depressive mixed states). Eur Psychiatry.. 2008; 23(1): 4048.
8. Mahli, GS, Lampe, L, Coulston, CM, et al. Mixed State discrimination: a DSM problem that won’t go away? J Affect Disord. 2014; 158: 810.
9. Takeshima, M, Oka, T. 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): 109116.
10. Perugi, G, Angst, J, Azorin, J-M, et al. Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study. J Clin Psychiatry. 2015; 76(3): e351e358.
11. Akiskal, HS, Benazzi, F. Family history validation of the bipolar nature of depressive mixed states. J Affect Disord. 2003; 73(1–2): 113122.
12. Angst, J, Cui, L, Swendsen, J, et al. Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry. 2010; 167(10): 11941201.
13. Goldberg, JF, Perlis, RH, Bowden, CL, et al. Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD. Am J Psychiatry. 2009; 166(2): 173181.
14. Fiedorowicz, JG, Endicott, J, Leon, AC, Solomon, DA, Keller, MB, Coryell, WH. Subthreshold hypomanic symptoms in progression from unipolar major depression to bipolar disorder. Am J Psychiatry. 2011; 168(1): 4048.
15. Angst, J, Cui, L, Swendsen, J, et al. Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry. 2010; 167(10): 11941201.
16. Dudek, D, Siwek, M, Zielińska, D, Jaeschke, R, Rybakowski, J. 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): 112115.
17. Sharma, V, Khan, M, Smith, A. A closer look at treatment resistant depression: is it due to bipolar diathesis? J Affect Disord. 2005; 84(2–3): 251257.
18. Rihmer, Z, Gonda, X. Antidepressant-resistant depression and antidepressant-associated suicidal behavioir: the role of underlying bipolarity. Depression Research and Treatment. 2011; 2011: 906462.
19. Amsterdam, JD, Shults, J. Does tachyphylaxis occur after repeated antidepressant exposure in patients with bipolar II major depressive episode? J Affect Disord. 2009; 115(1–2): 234240.
20. Post, RM, Leverich, GS, Altshuler, LL, et al. Relationship of prior antidepressant exposure to long-term prospective outcome in bipolar I disorder outpatients. J Clin Psychiatry. 2012; 73(7): 924930.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
  • URL: /core/journals/cns-spectrums
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 132
Total number of PDF views: 786 *
Loading metrics...

Abstract views

Total abstract views: 937 *
Loading metrics...

* Views captured on Cambridge Core between 8th March 2017 - 26th April 2018. This data will be updated every 24 hours.

A correction has been issued for this article: