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Mixed features in major depressive disorder: diagnoses and treatments

Published online by Cambridge University Press:  02 May 2017

Trisha Suppes  and
Michael Ostacher
Trisha Suppes*
Affiliation:
VA Palo Alto Health Care System, Palo Alto, California, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
Michael Ostacher
Affiliation:
VA Palo Alto Health Care System, Palo Alto, California, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
*
*Address for correspondence: Trisha Suppes, MD, PhD, VA Palo Alto Health Care System, 3801 Miranda Ave. 151T, Palo Alto, CA 94304, USA. (Email: tsuppes@stanford.edu)
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Abstract

For the first time in 20 years, the American Psychiatric Association (APA) updated the psychiatric diagnostic system for mood disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Perhaps one of the most notable changes in the DSM-5 was the recognition of the possibility of mixed symptoms in major depression and related disorders (MDD). While MDD and bipolar and related disorders are now represented by 2 distinct chapters, the addition of a mixed features specifier to MDD represents a structural bridge between bipolar and major depression disorders, and formally recognizes the possibility of a mix of hypomania and depressive symptoms in someone who has never experienced discrete episodes of hypomania or mania. This article reviews historical perspectives on “mixed states” and the recent literature, which proposes a range of approaches to understanding “mixity.” We discuss which symptoms were considered for inclusion in the mixed features specifier and which symptoms were excluded. The assumption that mixed symptoms in MDD necessarily predict a future bipolar course in patients with MDD is reviewed. Treatment for patients in a MDD episode with mixed features is critically considered, as are suggestions for future study. Finally, the premise that mood disorders are necessarily a spectrum or a gradient of severity progressing in a linear manner is argued.

Keywords

Atypical antipsychoticsdiagnosismajor depressionmixed featuresmixed symptomsmood disorderstreatment
Type
Review Articles
Information
CNS Spectrums , Volume 22 , Issue 2: Theme: Mixed features in major depressive episodes , April 2017 , pp. 155 - 160
Copyright
© Cambridge University Press 2017 

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