A Retrospective Comparison of Inpatients with Mixed and Pure Depression

Ducrey, Séverine; Gex‐Fabry, Marianne; Dayer, Alexandre; Pardos, Emna Ragama; Roth, Loraine; Aubry, Jean‐Michel; Bertschy, Gilles

doi:10.1159/000075187

Cited by 25 publications

(19 citation statements)

References 30 publications

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“…We also found a large proportion of women and a relatively later onset age, in agreement with Kraepelin [10]. In the literature, it is unclear whether mixed depressive patients have earlier [11,12,14], similar [9,13] or later [10] onset of illness, compared to other mood disorder patients. Family history of mood disorder was very common, though rapid cycling was less common than in DSM-defined bipolar disorder (11% vs. a typical rate of about 25%) [49].…”

Section: Discussionsupporting

confidence: 89%

“…Family history of mood disorder was very common, though rapid cycling was less common than in DSM-defined bipolar disorder (11% vs. a typical rate of about 25%) [49]. These results agree with many [13,15,21,50,51], but not all [9,11,12,13,14,22,23] previous reports on broadly defined mixed depressive states.…”

Section: Discussionsupporting

confidence: 84%

“…Although studies indicate that the incidence of mixed depression (MxD) among mood disorders is high [6,7,8,9], data regarding age at onset [9,10,11,12,13,14], gender [9,15], role of temperament [16,17,18,19,20,21], and family history of bipolar disorder (BD) [14,21,22,23] are unclear or contrasting. …”

Section: Introductionmentioning

confidence: 99%

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Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Sani¹,

Napoletano

Vöhringer

et al. 2014

Psychother Psychosom

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Background: Mixed depression (MxD) is narrowly defined in the DSM-IV and somewhat broader in the DSM-5, although both exclude psychomotor agitation as a diagnostic criterion. This article proposes a clinical description for defining MxD, which emphasizes psychomotor excitation. Methods: Two hundred and nineteen consecutive outpatients were diagnosed with an MxD episode using criteria proposed by Koukopoulos et al. [Acta Psychiatr Scand 2007;115(suppl 433):50-57]; we here report their clinical features and antidepressant-related effects. Results: The most frequent MxD symptoms were: psychic agitation or inner tension (97%), absence of retardation (82%), dramatic description of suffering or weeping spells (53%), talkativeness (49%), and racing or crowded thoughts (48%). MxD was associated with antidepressants in 50.7% of patients, with similar frequency for tricyclic antidepressants (45%) versus selective serotonin reuptake inhibitors (38.5%). Positive predictors of antidepressant-associated MxD were bipolar disorder type II diagnosis, higher index depression severity, and higher age at index episode. Antipsychotic or no treatment was protective against antidepressant-associated MxD. Conclusions: MxD, defined as depression with excitatory symptoms, can be clinically identified, is common, occurs in both unipolar depression and bipolar disorder, and is frequently associated with antidepressant use. If replicated, this view of MxD could be considered a valid alternative to the DSM-5 criteria for depression with mixed features.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 84%

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Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Sani¹,

Napoletano

Vöhringer

et al. 2014

Psychother Psychosom

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“…There are descriptions of mixed depression in Falret’s ‘circular insanity’ [39], Hecker’s ‘cyclothymia’ [40], and in Kraepelin’s ‘manic-depressive insanity’ [3]. Mixed depression has recently been described in BP-I, BP-II, and MDD [35, 38,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Frequency of mixed depression, defined as an MDE plus at least 2 or 3 noneuphoric manic/hypomanic symptoms, was up to 70% in BP, and up to 30% in MDD.…”

Section: Resultsmentioning

confidence: 99%

Is There a Continuity between Bipolar and Depressive Disorders?

Benazzi¹

2007

Psychother Psychosom

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Background: Recent studies questioned the current categorical split of mood disorders into bipolar disorders (BP) and depressive disorders (MDD). Methods: Medline database search of papers from the last 10 years on the categorical-dimensional classification of mood disorders. Various combinations of the following key words were used: mood disorders, bipolar, unipolar, major depressive disorder, spectrum, category/categorical, classification, continuity. Only English language clinical papers were included, review papers were excluded, similar papers selected by quality. The number of papers found was 1,141. The number of papers selected was 109. Results: The continuity/spectrum between BP (mainly BP-II) and MDD was supported by the following findings:(1) high frequency of mixed states (mixed mania, mixed hypomania, mixed depression, i.e. co-occurring depression and noneuphoric manic/hypomanic symptoms) because opposite polarity symptoms in the same episode do not support a hypomania/mania-depression splitting; (2) MDD was the most common mood disorder in BP probands’ relatives; (3) no bimodal distribution of distinguishing symptoms between BP and MDD; (4) bipolar signs not uncommon in MDD; (5) many MDD shifting to BP; (6) many lifetime manic/hypomanic symptoms in MDD; (7) correlation between lifetime manic/hypomanic symptoms and MDD symptoms; (8) hypomania factors in MDD; (9) MDD often recurrent; (10) similar cognitive style.The categorical distinction between BP (mainly BP-I) and MDD was supported by the following findings: (1) BP more common in BP probands’ relatives; (2) lower age at BP onset; (3) females as common as males in BP-I, more common than males in MDD; (4) BP-I depression more atypical and retarded, MDD depression more sleepless and agitated; (5) BP more recurrent. Conclusions: Focusing on mood spectrum’s extremes (BP-I vs. MDD), a categorical distinction seems supported. Focusing on midway disorders (BP-II and MDD plus bipolar signs), a continuity/spectrum seems supported. Results seem to support both a categorical and a dimensional view of mood disorders.

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“…Other, less frequently observed symptoms include increased talkativeness, increased sexual drive and distractibility. Its proximity to the bipolar spectrum has been well established [16,17,20] , yet the issue of the number of hypomanic symptoms needed to define a mixed depressive state remains unresolved [17,18,21] . Its interepisode stability has been less thoroughly studied but may be present in a subgroup of patients [22] .…”

mentioning

confidence: 99%

Frequency of Dysphoria and Mixed States

Bertschy

Gervasoni²,

Favre³

et al. 2008

Psychopathology

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Background: Mixed states are a complex entity in the field of mood disorders. Dysphoria has been advocated as an important clinical dimension of mixed states. The objective of this work is to study the frequency of dysphoria within a population of patients with DSM-IV major depressive and/or manic episodes and to determine if it may help establish diagnostic criteria for subthreshold cases of depressive or manic mixed states. Sampling and Methods: A total of 165 patients were assessed using the Mini International Neuropsychiatric Interview complemented by a section defining dysphoria as a constellation of 3 among 4 symptoms (inner tension, irritability, aggressive behavior and hostility). Results: When classifying patients according to the number of symptoms of the opposite polarity, changes in the frequency of dysphoria revealed a clear contrast between the 2 opposite manic and depressive poles and the full mixed state (DSM-IV definition). The frequency of dysphoria was 17.5% in pure depression, 22.7% in pure mania and 73.3% in full mixed state. Two threshold effects were identified: (1) the frequency of dysphoria increased from 17.5 to 61.1% (p = 0.002) when the number of manic symptoms in DSM-IV depressed patients increased from 0 to 1, and (2) dysphoria increased from 14.3 to 69.2% (p = 0.057) when the number of depressive symptoms increased from 2 to 3 in DSM-IV manic patients. Conclusion: Dysphoria is strongly but not necessarily associated with mixed states. When used as a clinical marker for mixed states, dysphoria confirms the modern delimitations of sub-threshold mixed states by specifying the required number of symptoms of the opposite polarity (which could be lower for depressive mixed states than for manic mixed states). The study has limitations related to the inclusion of patients who are not drug-free, to the definition of dysphoria and to the sample size.

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A Retrospective Comparison of Inpatients with Mixed and Pure Depression

Cited by 25 publications

References 30 publications

Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Is There a Continuity between Bipolar and Depressive Disorders?

Frequency of Dysphoria and Mixed States

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