Major Depressive Disorder with Mixed Features – A Rapid Review

Posted on:June 28, 2020
Last Updated: July 6, 2023
Time to read: 4 minutes

Depressive disorder with mixed features (DMX), also known as a mixed episode, a mixed state or agitated depression, is a term used in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to describe a condition in which the symptoms of mania or sub-syndromal mania occur during the depressive disorders of either Major Depressive Disorder or Bipolar I or II disorder.

Mixed depression deserves its own diagnostic identity, with inner psychic agitation as its central feature, even if the DSM system needs to be overhauled in the process. Only then can we meet Aubrey Lewis’ challenge to be both useful and valid in our nosology. [Koukopoulos A, 2014]

The disorder can be conceptualised as lying at the cusp between depression and mania.

Currently, only one treatment guideline exists for major depressive episode with mixed features (i.e., the Florida Best Practice Psychotherapeutic Medication Guidelines for Adults [2015], available for download here.

This article summarises the recent guidelines published by Stahl S et al. 2017.

For an up-to-date CPD course, visit the Academy course on Mixed Depression.