Major Depression With Subsyndromal Mania/Hypomania: Implications for Diagnosis and Management
Trisha Suppes, MD, PhD, Stanford University School of Medicine, Roger S. McIntyre, MD, FRCPC, University of Toronto, and J. Craig Nelson, MD, University of California, San Francisco
In an industry-sponsored symposium, Dr. Suppes described the history and DSM-5 diagnostic features of the mixed features specifier for major depressive disorder and bipolar disorder. Dr. Nelson explained that because mixed states is a new specifier, there are few studies examining treatment, but studies of bipolar depression are informative. Specific anticonvulsants and atypical antipsychotics have been approved to treat bipolar depression. In a randomized, double-blind, placebo-controlled trial, flexibly dosed lurasidone was more effective in the primary outcome, which was mean change in Montgomery-Åsburg Depression Rating Scale score from baseline, and response and remission rates. Dr. McIntyre reviewed medical comorbidities found in mixed states, including obesity, cardiovascular disease, and metabolic syndrome. Inflammatory processes may play a role in medical issues seen in patients with a mood disorder.
