title: Mixed depression: clinical features and predictors of its onset associated with antidepressant use.
abstract: 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.
authors: NESMOS Department (Neuroscience, Mental Health, and Sensory Organs), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Gabriele
authors: G
authors: Sani
authors: Flavia
authors: F
authors: Napoletano
authors: Paul A
authors: PA
authors: Vöhringer
authors: Matthew
authors: M
authors: Sullivan
authors: Alessio
authors: A
authors: Simonetti
authors: Athanasios
authors: A
authors: Koukopoulos
authors: Emanuela
authors: E
authors: Danese
authors: Paolo
authors: P
authors: Girardi
authors: Nassir
authors: N
authors: Ghaemi
mesh_terms: D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors