DSM‐5 criteria for depression with mixed features: a farewell to mixed depression
Abstract
Objective To review the DSM-5 proposed criteria for mixed depression in light of robust and consistent historical and scientific evidence. Method An extensive historical search, a systematic review of the papers used by DSM-5 as reference papers, and a PubMed search were performed. Results As Hippocrates, depressive mixed states have been described as conditions of intense psychic suffering, consisting of depressed mood, inner tension, restlessness, and aimless psychomotor agitation. In DSM-5, new criteria are proposed for a mixed features specifier, as part of depression either in major depressive disorder (MDD) or bipolar disorder. Those criteria require, as diagnostically specific, manic/hypomanic symptoms that are the least common kinds of symptoms that actually arise in depressive mixed states. The DSM-5 proposal is based, almost entirely, on a speculative wish to avoid 'overlapping' manic and depressive symptoms. Mixed states are, in fact, nothing but overlapping manic and depressive symptoms. Conclusion In this article, we review the psychopathology and research on mixed depressive states, and try to demonstrate that the DSM-5 proposal has weak scientific basis and does not identify a large number of mixed depressive states. This may be harmful because of the different treatment required by these conditions.
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DSM-5 characterization of major depression with mixed features has been criticized because it does not include several elements regarded as characteristic of mixed depression in classic and recent literature (irritability and agitation).
“The DSM-5 characterization of major depression with mixed features has been criticized, because it does not include several elements that are regarded as characteristic of mixed depression in both the classic and the recent literature (i.e., irritability and agitation) 50 .”
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 [50]
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- Authors
- Koukopoulos, A., & Sani, G.
- Affiliations
- Centro Lucio Bini Rome Italy
- Azienda Ospedaliera Sant'Andrea (IT)
- Corresponding author
- Koukopoulos, A.
- ORCID
- Sani, G.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2013-04-19
- Volume
- 129
- Issue
- 1
- Pages
- 4-16
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2041765341
- Cited by
- 181
- References
- 6
- Citations by year
- 2026: 9 · 2025: 5 · 2024: 7 · 2023: 7 · 2022: 9 · 2021: 11 · 2020: 15 · 2019: 21 · 2018: 11 · 2017: 18 · 2016: 19 · 2015: 32 · 2014: 12 · 2013: 5
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- 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
- mixed depression, DSM-5 diagnostic criteria, major depressive disorder, bipolar disorder, manic symptoms, depressive mixed state, psychomotor agitation, diagnostic classification
- MeSH terms
- Bipolar Disorder, Major Depressive Disorder, Depressive Disorder, Humans, Psychomotor Agitation, Diagnostic and Statistical Manual of Mental Disorders
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