Mixed depression: A study of its phenomenology and relation to treatment response

Pae, Chi Un; Vöhringer, Paul A.; Holtzman, Niki S.; Thommi, Sairah; Patkar, Ashwin A.; Gilmer, William S.; Ghaemi, S. Nassir

doi:10.1016/j.jad.2011.11.024

Cited by 27 publications

(33 citation statements)

References 15 publications

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“…6,11,13,14 It is not clear why the magnitude of the lurasidone treatment effect observed in the current study was larger among patients with irritable features. Larger MADRS effect sizes appeared to be attributable, in part, to reduced improvement on placebo among patients with (vs. without) irritability (MADRS change = -9.5 vs. -13.8, respectively), while improvement on lurasidone was somewhat higher among patients with (vs. without) irritability (MADRS change = -22.6 vs. -19.9, respectively).…”

Section: Discussioncontrasting

confidence: 56%

“…8,17,20,21,34,35 The presence of irritability complicates the clinical picture of MDD with mixed features and may further increase treatment resistance to standard antidepressants. 6,[11][12][13][14][15] In the first prospective placebo-controlled trial in MDD with subthreshold hypomania (mixed features), lurasidone demonstrated significant efficacy in improving the symptoms of depression and subthreshold hypomanic symptoms. 29 The post-hoc analysis reported here now extends these results by finding lurasidone to have significant efficacy in MDD with mixed features patients who also presented with irritability (defined by the attainment of threshold scores on two irritability-related YMRS items).…”

Section: Discussionmentioning

confidence: 99%

“…14,15 MDD with mixed features is a common and often severe subtype of major depression that is recognized by the mixed-features specifier in DSM-5. 8 Prevalence estimates from clinical populations indicate that mixed features occur in at least 25% of patients with MDD.…”

Section: Introductionmentioning

confidence: 99%

“…8 Prevalence estimates from clinical populations indicate that mixed features occur in at least 25% of patients with MDD. 11,14,[16][17][18][19][20][21][22] Irritability is not included as a criterion for mixed features in DSM-5, in part due to concerns regarding specificity. 8 Despite the prevalence and prognostic significance of irritability in MDD (with or without mixed features), few prospective studies have examined treatment response in this important clinical population.…”

Section: Introductionmentioning

confidence: 99%

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Lurasidone for major depressive disorder with mixed features and irritability: a post-hoc analysis

et al. 2017

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Objective. The aim of this post-hoc analysis was to evaluate the efficacy of lurasidone in treating major depressive disorder (MDD) with mixed features including irritability.Methods. The data in this analysis were derived from a study of patients meeting DSM-IV-TR criteria for unipolar MDD, with a Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≥26, presenting with two or three protocol-defined manic symptoms, and who were randomized to 6 weeks of double-blind treatment with either lurasidone 20-60 mg/d (n = 109) or placebo (n = 100). We defined "irritability" as a score ≥2 on both the Young Mania Rating Scale (YMRS) irritability item (#5) and the disruptive-aggressive item (#9). Endpoint change in the MADRS and YMRS items 5 and 9 were analyzed using a mixed model for repeated measures for patients with and without irritability.Results. Some 20.7% of patients met the criteria for irritability. Treatment with lurasidone was associated with a significant week 6 change vs. placebo in MADRS score in both patients with (-22.6 vs. -9.5, p < 0.0001, effect size [ES] = 1.4) and without (-19.9 vs. -13.8, p < 0.0001, ES = 0.7) irritability. In patients with irritable features, treatment with lurasidone was associated with significant week 6 changes vs. placebo in both the YMRS irritability item (-1.4 vs. -0.3, p = 0.0012, ES = 1.0) and the YMRS disruptive-aggressive item (-1.0 vs. -0.3, p = 0.0002, ES = 1.2).Conclusions. In our post-hoc analysis of a randomized, placebo-controlled, 6-week trial, treatment with lurasidone significantly improved depressive symptoms in MDD patients with mixed features including irritability. In addition, irritability symptoms significantly improved in patients treated with lurasidone.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lurasidone for major depressive disorder with mixed features and irritability: a post-hoc analysis

et al. 2017

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“…The contemporary literature on mixed mania focuses on the symptomatic presentations, pharmacological responses (Pae et al, 2012a;Patkar et al, 2012), biological substrates, and natural course of mixed states (Pae et al, 2012b) as well as demographic variables. In contrast to pure mania, mixed mania is more likely to affect women and people who have had past mixed episodes; involves a higher incidence of suicidal ideation, poorer response to lithium carbonate (Bowden et al, 1994), and shorter interepisode stability; and may be associated with neurological and developmental disorders, substance abuse, and other conditions (Dayer et al, 2000;Kruger et al, 2005;Kusumakar et al, 1997;McElroy et al, 1992).…”

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confidence: 99%

Reevaluation of Patients With Bipolar Disorder on Manic Episode

Kim

Cho

Kim

et al. 2013

Journal of Nervous &Amp; Mental Disease

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Mixed manic/depressive episodes in patients with bipolar disorder are underdiagnosed because of restrictive diagnostic criteria. Using the broader definition of a mixed episode represented by the Cincinnati criteria, we reevaluated the medical records of patients with bipolar disorder hospitalized for a manic episode. We also examined the predictive power of previously unrecognized depressive symptoms. Of 520 inpatients with mania, we retrospectively diagnosed 59 (11.3%) as having a probable mixed episode. Compared with the patients with pure mania, the patients with mixed episodes were more likely to have a family history of psychiatric illness, comorbid personality disorder, and a history of suicide attempts. Binary logistic regression revealed that loss of interest, loss of energy, feelings of worthlessness, and feelings of helplessness had good positive predictive value (>0.7) for mixed episodes. Accurate diagnosis of mixed episodes may require a broadening of diagnostic criteria and emphasis on symptoms such as loss of interest, loss of energy, and feelings of worthlessness and helplessness.

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Psychopathology of Depression in the Spectrum of Mood Disorders

Vöhringer

Arancibia

2021

Depression and Personality

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Mixed depression: A study of its phenomenology and relation to treatment response

Cited by 27 publications

References 15 publications

Lurasidone for major depressive disorder with mixed features and irritability: a post-hoc analysis

Lurasidone for major depressive disorder with mixed features and irritability: a post-hoc analysis

Reevaluation of Patients With Bipolar Disorder on Manic Episode

Psychopathology of Depression in the Spectrum of Mood Disorders

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