Host: Matt Birnholz, MD

Guest: Trisha Suppes, MD, PhD

Guest: Roger McIntyre, MD

Guest: J. Craig Nelson, MD

Subsyndromal mania/hypomania are prevalent among patients with major depressive disorder (MDD) and are frequently associated with comorbidities, including substance use disorders, panic disorder, poorer long-term clinical outcomes, and suicidality. Additionally, mixed features of mania/hypomania in depression are associated with more depressive episodes and more atypical features of depression. With the increased appreciation of this constellation of symptoms, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition introduced a “mixed features” specifier for patients with MDD and subsyndromal mania/hypomania. It has been shown that approximately 25% of patients with MDD meet the criteria for the mixed features specifier. The specifier allows clinicians to better tailor treatment for patients, particularly because some patients with mixed features may become less stable when receiving antidepressants. In addition, identifying symptoms of mania/hypomania may allow clinicians to recognize patients with MDD who are at risk of progression to bipolar disorder. The diagnosis and management of patients with MDD and mixed features of subsyndromal mania or hypomania can be challenging. A recent survey of clinicians demonstrated the need for education in the area of major depression with mixed features. In particular, respondents were frequently uncertain about the management and treatment options for patients with MDD and ...