New to the diagnosis of major depressive disorder as of DSM-5 is the specifier “with mixed features.” According to DSM-5, “specifiers provide an opportunity to define a more homogeneous subgrouping of individuals with the disorder who share certain features (e.g., major depressive disorder, with mixed features) and to convey information that is relevant to the management of the individual’s disorder.”
A study presented at the American Society of Clinical Psychopharmacology (ASCP) 2015 Annual Meeting, demonstrated that patients with MDD presenting with mixed (subthreshold hypomanic) features showed significantly greater improvement when treated with lurasidone vs placebo, as evidenced by scores on the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression–Severity (CGI-S) scale. This is the first randomized placebo-controlled, prospective study to evaluate this group of patients (n=109) who present with subthreshold manic or hypomanic features or irritability during a depressive episode and do not meet the criteria for bipolar disorder. It is estimated that 20% to 40% of patients with MDD may have mixed features.
The 6-week study presented by Trisha Suppes, MD, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, excluded any patients with a history of manic episodes or any mixed manic episodes. Treatment with lurasidone was demonstrated with significantly greater improvement compared with placebo from week 2 through 6 on both the depression and severity scales.