| dc.description.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 antide-pressant-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. | |
