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CNS Spectr. 2017 Apr;22(2):203-219. doi: 10.1017/S1092852917000165. Epub 2017 Feb 28.

Guidelines for the recognition and management of mixed depression.

Author information

1
1Department of Psychiatry,University of California,San Diego,California,USA.
2
3Neuroscience Education Institute,Carlsbad,California,USA.
3
4Lucio Bini Mood Disorders Center,New York,New York,USA.
4
5Department of Psychiatry,Massachusetts General Hospital,Boston,Massachusetts,USA.
5
6Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,New York,USA.
6
7Research Institute at the Lindner Center of HOPE,Mason,Ohio,USA.
7
8Mood Disorders Psychopharmacology Unit,University Health Network,Toronto,Ontario,Canada.
8
10Department of Psychiatry,University of Sydney,Sydney,Australia.
9
11Centro Lucio Bini,Rome,Italy.
10
12VA Palo Alto Health Care System,Palo Alto,California,USA.
11
14Hospital Clinic,Institute of Neuroscience,University of Barcelona,IDIBAPS,CIBERSAM,Barcelona,Catalonia,Spain.
12
15Psychiatry Clinic,Sainen,Kanazawa City,Ishikawa Prefecture,Japan.
13
16Department of Psychiatry,Perelman School of Medicine,University of Pennsylvania, and the Corporal Michael J. Crescenz Veterans Affairs Medical Center,Philadelphia,Pennsylvania,USA.
14
17Department of Psychological Medicine,Kings College,London,United Kingdom.
15
18Department of Psychiatry,Rhode Island Hospital,Providence,Rhode Island,USA.

Abstract

A significant minority of people presenting with a major depressive episode (MDE) experience co-occurring subsyndromal hypo/manic symptoms. As this presentation may have important prognostic and treatment implications, the DSM-5 codified a new nosological entity, the "mixed features specifier," referring to individuals meeting threshold criteria for an MDE and subthreshold symptoms of (hypo)mania or to individuals with syndromal mania and subthreshold depressive symptoms. The mixed features specifier adds to a growing list of monikers that have been put forward to describe phenotypes characterized by the admixture of depressive and hypomanic symptoms (e.g., mixed depression, depression with mixed features, or depressive mixed states [DMX]). Current treatment guidelines, regulatory approvals, as well the current evidentiary base provide insufficient decision support to practitioners who provide care to individuals presenting with an MDE with mixed features. In addition, all existing psychotropic agents evaluated in mixed patients have largely been confined to patient populations meeting the DSM-IV definition of "mixed states" wherein the co-occurrence of threshold-level mania and threshold-level MDE was required. Toward the aim of assisting clinicians providing care to adults with MDE and mixed features, we have assembled a panel of experts on mood disorders to develop these guidelines on the recognition and treatment of mixed depression, based on the few studies that have focused specifically on DMX as well as decades of cumulated clinical experience.

KEYWORDS:

Mixed; bipolar; depression; guidelines; unipolar

PMID:
28421980
DOI:
10.1017/S1092852917000165
[Indexed for MEDLINE]

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