Atypical depression with hypomanic symptoms

Background: Depressive mixed states (major depressive episodes with some hypomanic symptoms) (DMS) are not classified in DSM-IV and are understudied. The aims of this study were to find the prevalence and clinical features of DMS in atypical depression. Methods: A total of 87 bipolar II and unipolar depressed outpatients were interviewed within the DSM-IV Structured Clinical Interview. Results: More than two hypomanic symptoms were present in 50.0% of the atypical and 20.3% of the non-atypical depression cases (P=0.006). DMS mainly included irritable mood, distractibility, racing thoughts, and increased talking. Limitations: There was a single interviewer, and it was a non-blind, cross-sectional assessment, with bipolar II reliability. Conclusions: Findings have treatment implications, as antidepressants may worsen DMS, and mood stabilizers may improve it.