title: Mixed depression: a study of its phenomenology and relation to treatment response.
abstract: BACKGROUND
  Mixed depression reflects the occurrence of a major depressive episode with subsyndromal manic symptoms. Not recognized in DSM-IV, it is included in the proposed changes for DSM-5. Observational and cross-sectional studies have suggested that mixed depression is present in up to one-half of major depressive episodes, whether in MDD or bipolar disorder. Based on observational studies, antidepressants appear to be less effective, and neuroleptics more effective, in mixed than pure depression (major depressive episodes with no manic symptoms). In this report, we examine the specific manic symptoms that are most present in mixed depression, especially as they correlate with prospectively assessed treatment response.
  
  
  METHODS
  In 72 patients treated in a randomized clinical trial (ziprasidone versus placebo), we assessed the phenomenology of manic symptom type at study entry and their influence as predictors of treatment response.
  
  
  RESULTS
  The most common symptom presentation was a clinical triad of flight of ideas (60%), distractibility (58%), and irritable mood (55%). Irritable mood was the major predictor of treatment response. DSM-based diagnostic distinctions between MDD and bipolar disorder (type II) did not predict treatment response.
  
  
  CONCLUSIONS
  In this prospective study, mixed depression seems to be most commonly associated with irritable mood, flight of ideas, and distractibility, with irritability being an important predictor of treatment outcome with neuroleptic agents. If these data are correct, in the presence of mixed depression, the DSM-based dichotomy between MDD and bipolar disorder does not appear to influence treatment response.
authors.affiliation: Department of Psychiatry, Duke University Medical Center, Durham, NC, United States.
authors.forename: Chi-Un
authors.initials: CU
authors.lastname: Pae
authors.forename: Paul A
authors.initials: PA
authors.lastname: Vöhringer
authors.forename: Niki S
authors.initials: NS
authors.lastname: Holtzman
authors.forename: Sairah B
authors.initials: SB
authors.lastname: Thommi
authors.forename: Ashwin
authors.initials: A
authors.lastname: Patkar
authors.forename: William
authors.initials: W
authors.lastname: Gilmer
authors.forename: S Nassir
authors.initials: SN
authors.lastname: Ghaemi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy; D003863:Depression; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007508:Irritable Mood; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents