Mixed Features in Depression

Pacchiarotti, Isabella; Kotzalidis, Giorgio D.; Murru, Andréa; Mazzarini, Lorenzo; Rapinesi, Chiara; Valentí, Marc; Anmella, Gerard; Gomes‐da‐Costa, Susana; Giménez, Anna; Llach, Cristian-Daniel; Perugi, Giulio; Vieta, Eduard; Verdolini, Norma

doi:10.1016/j.psc.2019.10.006

Cited by 30 publications

(8 citation statements)

References 37 publications

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“…As a result, we opted to use bilateral TBS (right cTBS and left iTBS) protocol in mixed depression treatment. Mixed states are difficult to treat and are often hidden in treatment-resistant samples [66][67][68][69][70][71]. In particular, the treatment of depressive symptoms in mixed depression represents a clinical dilemma, mainly because conventional antidepressant medications commonly worsen instability and intra-episodic mood changes [72][73][74].…”

Section: Discussionmentioning

confidence: 99%

Treatment of mixed depression with theta-burst stimulation (TBS): results from a double-blind, randomized, sham-controlled clinical trial

Tavares

Suen

Santos

et al. 2021

Neuropsychopharmacol.

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Mixed depression is probably different in terms of clinical course and response to treatment. Repetitive transcranial magnetic stimulation (rTMS) is well established in non-mixed depression, and theta-burst stimulation (TBS) protocol is replacing conventional protocols because of noninferiority and reduced delivery time. However, TBS has not been adequately studied in mixed states. This study was a double-blind, six-week, sham-controlled, and randomized clinical trial of bilateral TBS targeting the right and left dorsolateral prefrontal cortex, respectively. Adults with bipolar and major depressive disorder experiencing an acute mixed depression were eligible if they had not benefited from a firstor second-line treatment for acute unipolar or bipolar depression recommended by the Canadian Network for Mood and Anxiety Treatments. Out of 100 patients included, 90 composed modified intention-to-treat sample, which was patients that completed at least one week of the intervention. There were no significant differences in Montgomery-Asberg depression rating scale score changes (least squares mean difference between groups at week 3, −0.06 [95% CI, − 3.39 to 3.51; P = 0.97] in favor of sham TBS). Response and remission rates per MADRS were also not statistically different among active and sham groups (35.7% vs. 43.7%, and 28.5% vs. 37.5% respectively at week 6, ps > 0.51). No other analyses from baseline to weeks 3 or 6 revealed significant time x group interaction or mean differences among groups in the mITT sample. Bilateral TBS targeting the DLPFC is not efficacious as an add-on treatment of acute bipolar and unipolar mixed depression. ClinicalTrials.govIdentifier: NCT04123301

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Section: Discussionmentioning

confidence: 99%

Treatment of mixed depression with theta-burst stimulation (TBS): results from a double-blind, randomized, sham-controlled clinical trial

Tavares

Suen

Santos

et al. 2021

Neuropsychopharmacol.

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“…These forms have a prolonged duration due to various factors, such as a high rate of comorbidity [ 9 ]. Most of these mixed features, particularly those with depressive episodes, still fail to be detected by the current nosological systems, which require a full symptomatic picture of both major depressive and manic episodes, or major depressive and hypomanic episodes [ 10 ]. Furthermore, the duration of manic and depressive symptoms and their co-occurrence are inadequately defined.…”

Section: Clinical Presentations Of Depressive Mixed Statesmentioning

confidence: 99%

A reevaluation of mixed depressive states from the DSM-5- TR perspective: a series of prototypical cases

Pini,

Raia,

Amatori

2024

Arch Clin Cases

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Mixed depressive states are defined by the co-presence of depressive and manic symptoms. They represent extremely variable conditions from the point of view of clinical expressiveness and are difficult to recognize, ranging from clear schizophrenic-like psychoses and pseudodemented pictures to subsyndromal psychopathology. At the basis of the extreme variability of depressive pictures with mixed features are the different combinations that depressive and manic symptoms can assume. Furthermore, the intensity of depressive symptoms and manic symptoms, combined, can be variable, a factor that contributes to making the picture even more variable. Each form of mixed depressive state therefore presents its own specific symptomatic characteristics and specific difficulties in differential diagnosis and each form requires a different therapeutic strategy. In this work we have distinguished four possible specific subtypes of mixed depressive states, describing their specific clinical presentation and the therapeutic options most supported by the literature with the aim of contributing to a better recognition of mixed depressive states, to avoid incorrect diagnoses at patient and treatments that are useless if not worsening.

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“…Benazzi 6 found that hyperactivity was the most common symptom among patients with BD type 2, surpassing elevated mood, and was the symptom most associated with the diagnosis. Some authors 33,34 proposed that the presence of increased motor activity during a depressive episode would indicate the occurrence of a mixed state. In a study with 7,689 patients who were currently experiencing a major depressive episode, Barbuti et al 35 found that psychomotor agitation was more associated with bipolar spectrum features when compared with psychomotor retardation.…”

Section: Test Information Functionmentioning

confidence: 99%

Mood or energy/activity symptoms in bipolar mania: which are the most informative?

Cheniaux¹,

Anunciação²,

Landeira-Fernández³

et al. 2023

Trends Psychiatry Psychother

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Introduction: Bipolar disorder (BD) in DSM-III and DSM-IV is classified as a mood disorder and requires the presence of a mood change, i.e., euphoria or irritability. Differently, DSM-5 states that there must be some increase in energy or motor activity in addition to the mood change.Objective: Our aim was to identify which types of symptoms (i.e., mood-or energy/activityrelated symptoms) are the most informative in a manic episode.Method: Symptoms of manic episodes in 106 outpatients with BD were assessed through the Young Mania Rating Scale between November 2002 and November 2015 in a naturalistic study. The items of the scale were divided into three groups according to clinical criteria: mood, energy/activity, and other. The Samejima Graded Response Model of the Item Response Theory was computed as well as the Test Information Function for comparisons between groups. Chi-squared tests were used to verify the association between the groups of symptoms by comparing the area under the curve of the TIF results. Results:The information accounted for energy/activity represents 77% of the proportion of the total TIF; about 23% is related to mood and other groups of symptoms. Both proportions are statistically different (X2(1) = 30.42, p < 0.001) Conclusion: On average, changes in energy/activity tend to be more informative than mood changes during the manic phases of BD.

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Mixed Features in Depression

Cited by 30 publications

References 37 publications

Treatment of mixed depression with theta-burst stimulation (TBS): results from a double-blind, randomized, sham-controlled clinical trial

Treatment of mixed depression with theta-burst stimulation (TBS): results from a double-blind, randomized, sham-controlled clinical trial

A reevaluation of mixed depressive states from the DSM-5- TR perspective: a series of prototypical cases

Mood or energy/activity symptoms in bipolar mania: which are the most informative?

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