Proposed DSM-5 mixed features are associated with greater likelihood of remission in out-patients with major depressive disorder
Open accessAbstract
Background: Draft DSM-5 criteria for a mixed major depressive episode have been proposed, but their predictive validity has not yet been established. We hypothesized that such symptoms would be associated with poorer antidepressant treatment outcomes. Method: We examined outcomes among individuals with major depressive disorder participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an effectiveness study conducted at primary and specialty care centers in the USA. Mixed features were derived from the six self-report items of the mania subscale of the Psychiatric Diagnosis Screening Questionnaire. Primary analyses examined the association between the presence of at least two of these in the 6 months before study entry, and remission across up to four sequential treatment trials, as well as adverse outcomes. Results: Of the 2397 subjects with a major depressive episode of at least 6 months' duration, 449 (18.7%) reported at least two mixed symptoms. The presence of such symptoms was associated with a greater likelihood of remission across up to four sequential treatments, which persisted after adjustment for potential confounding clinical and demographic variables (adjusted hazard ratio 1.16, 95% confidence interval 1.03–1.28). Two individual items, expansive mood and cheerfulness, were strongly associated with a greater likelihood of remission. Conclusions: Proposed DSM-5 mixed state features were associated with a greater rather than a lesser likelihood of remission. While unexpected, this result suggests the potential utility of further investigation of depressive mixed states in major depression.
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Implications of a DSM-5 diagnosis of major depression with mixed features in terms of treatment response have been found to be different from those of mixed depression as usually defined in literature.
“Indeed, the implications of a DSM-5 diagnosis of major depression with mixed features in terms of treatment response have been found to be different from those of mixed depression as usually defined in the literature 51 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [51]
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- Authors
- Perlis, R. H., Cusin, C., & Fava, M.
- Affiliations
- Harvard University (US)
- Corresponding author
- Perlis, R. H.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2012-03-15
- Volume
- 44
- Issue
- 7
- Pages
- 1361-1367
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC10034819
- OpenAlex
- W2170857140
- Cited by
- 35
- References
- 21
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 3 · 2018: 1 · 2017: 5 · 2016: 4 · 2015: 3 · 2014: 4 · 2013: 3 · 2012: 2
- FWCI
- 2.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health and Human Services
- National Institutes of Health (n01mh90003-26-0-0)
- National Institute of Mental Health (N01‐MH‐90003, MH90003, N01 MH090003, MH-086026, R01MH086026)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- major depressive disorder, mixed features, DSM-5, depressive mixed state, remission, antidepressant treatment outcome, STAR*D, cheerfulness, treatment-resistant depression
- MeSH terms
- Adult, Aged, Antidepressive Agents, Bipolar Disorder, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Outpatients, Remission Induction, Citalopram, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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