What is the role of conventional antidepressants in the treatment of major depressive episodes with Mixed Features Specifier?
The newly introduced Mixed Features Specifier of Major Depressive Episode and Disorder (MDE/MDD) is especially challenging in terms of pharmacological management. Prior to the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of the mixed features specifier were intradepressive hypomanic symptoms, always and only associated with bipolar disorder (BD). Intradepressive hypomanic symptoms, mostly referred to as depressive mixed states (DMX), have been poorly characterized, and their treatment offers significant challenges. To understand the diagnostic context of DMX, we trace the nosological changes and collocation of intradepressive hypomanic symptoms, and examine diagnostic and prognostic implications of such mixed features. One of the reasons so little is known about the treatment of DMX is that depressed patients with rapid cycling, substance abuse disorder, and suicidal ideation/attempts are routinely excluded from clinical trials of antidepressants. The exclusion of DMX patients from clinical trials has prevented an assessment of the safety and tolerability of short- and long-term use of antidepressants. Therefore, the generalization of data obtained in clinical trials for unipolar depression to patients with intradepressive hypomanic features is inappropriate and methodologically flawed. A selective review of the literature shows that antidepressants alone have limited efficacy in DMX, but they have the potential to induce, maintain, or worsen mixed features during depressive episodes in BD. On the other hand, preliminary evidence supports the effective use of some atypical antipsychotics in the treatment of DMX.
1Lucio Bini Mood Disorders Center,New York,New York,USA.
Gianni L
GL
Faedda
2Centro Lucio Bini,Rome,Italy.
Ciro
C
Marangoni
D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004359:Drug Therapy, Combination; D019983:Guideline Adherence; D006801:Humans; D015983:Selection Bias; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents
Antidepressant; bipolar disorder; major depression; mixed features; mixed states