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Psychol Med. 2014 May;44(7):1361-7. doi: 10.1017/S0033291712000281. Epub 2012 Mar 15.

Proposed DSM-5 mixed features are associated with greater likelihood of remission in out-patients with major depressive disorder.

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1
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Abstract

BACKGROUND:

Draft DSM-5 criteria for a mixed major depressive episode have been proposed, but their predictive validity has not yet been established. We hypothesized that such symptoms would be associated with poorer antidepressant treatment outcomes.

METHOD:

We examined outcomes among individuals with major depressive disorder participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an effectiveness study conducted at primary and specialty care centers in the USA. Mixed features were derived from the six self-report items of the mania subscale of the Psychiatric Diagnosis Screening Questionnaire. Primary analyses examined the association between the presence of at least two of these in the 6 months before study entry, and remission across up to four sequential treatment trials, as well as adverse outcomes.

RESULTS:

Of the 2397 subjects with a major depressive episode of at least 6 months' duration, 449 (18.7%) reported at least two mixed symptoms. The presence of such symptoms was associated with a greater likelihood of remission across up to four sequential treatments, which persisted after adjustment for potential confounding clinical and demographic variables (adjusted hazard ratio 1.16, 95% confidence interval 1.03-1.28). Two individual items, expansive mood and cheerfulness, were strongly associated with a greater likelihood of remission.

CONCLUSIONS:

Proposed DSM-5 mixed state features were associated with a greater rather than a lesser likelihood of remission. While unexpected, this result suggests the potential utility of further investigation of depressive mixed states in major depression.

PMID:
22417535
DOI:
10.1017/S0033291712000281
[Indexed for MEDLINE]
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