Among the Mixed States, forms of Depression with severe agitation and excitatory symptoms of Hypomania are extremely common. These forms are often called Anxious or Agitated Depression. Their importance lies in the severity of these conditions due to:
 a great risk of suicidal behavior, and in
 the frequent worsening of symptoms with antidepressant agents.

We found the most common symptoms reported in these forms include:

"We observe also clinical 'mixed forms', in which the phenomena of Mania and melancholia are combined with each other, so that states arise, which indeed are composed of the same morbid symptoms as these, but cannot without coercion be classified either with the one or with the other. Our customary grouping into manic and melancholic attacks does not fit the facts, if it is to reproduce nature."

Characterized by increased sleep and appetite with carbohydrate craving, Atypical Depression is the most common among patients with MDI. Decreased energy, impaired concentration and low sexual drive are prominent features. The increased emotional reactivity and the preferential response to some antidepressants (MAOI) point to MDI as the underlying cause of these symptoms.

Growing evidence about the differences between the depressive phase of MDI and other forms of depression have been collected in research studies. Parker documented the differences between forms of Depression among patients with or without MDI. The presence of psychomotor retardation, melancholic and psychotic features are consistently more common in MDI than in other forms of depression.

Depressive symptoms are almost always present in people suffering from MDI. Depressive symptoms can vary in severity, type and duration, occurring in alternation with manic/hypomanic symptoms, in combination with them, or in their absence. Different forms or subtypes of MDI can be identified. Different types of depression have been described from a subtle, lingering form called Dysthymia to the short-lived depressive phases of Cyclothymia or the full-blown Major Depression in its recurrent, chronic or Atypical forms. For a review on Depression, see Preskorn.

Mania can occur in a variety of clinical manifestations, including a classic, euphoric form, a dysphoric or irritable form, a mixed state, a mild form (hypomania), or a subsyndromal form (hyperthymia), often referred to as Temperament. A general feeling of wellness and eutonia is quite common in the euphoric forms but not in dysphoric mania.

Mania causes impaired judgment and poor impulse control. A manic patient might seek out dangerous, risk-taking behaviors, including impulsive spending, sexual promiscuity, aggressive driving and speeding, substance abuse, and violent or criminal behavior.

The presence of a depressed or unpleasant mood during an episode of Mania produces a clinical picture called Dysphoric Mania. This term has been used to describe several different clinical conditions, including Irritable, Mixed and Anxious Mania. (McElroy, Hantouche)

In these syndromes, manic symptoms are prominent and often severe. The lack of euphoria however, confers to these forms a particularly painful quality. The patient suffering from these forms of Mania is highly irritable, hostile, and prone to angry outbursts or rage. When contradicted or confronted with the consequences of his behavior, the patient can become abusive, violent and destructive.

"Manic-depressive insanity" includes on the one hand the whole domain of the so called periodic and circular insanity, on the other hand simple mania, the greatest part of the morbid states termed melancholia"
-Kraepelin

The symptoms of MDI can be extremely variable from person to person, remaining fairly consistent over time in the same person. Some will experience both Mania and Depression. Others only or mostly Mania, Depression, or Mixed States.

Developed for use in research, diagnostic criteria has been used in clinical practice to diagnose mental illnesses. This practice has some benefits and many risks. One of the benefits has been to provide a common language for researchers and clinicians, allowing for greater consistency and making possible the exchange of research and clinical data between centers around the world and between clinicians with different backgrounds.

“Manic-depressive insanity…(includes) certain slight and slightest colourings of mood, some of them periodic, some of them continuously morbid, which on the one hand are to be regarded as the rudiment of more severe disorders, on the other hand pass without sharp boundary into the domain of personal predisposition. In the course of the years I have become more and more convinced that all the above mentioned states only represent manifestations of a single morbid process.”

To grasp some of the complexities of MDI it is best to focus our attention on the following aspects of this illness.

Polarity of MDI is the predominant clinical feature. Mania and Depression are the ones that have been studied most extensively.

Mixed States are the result of coexisting and overlapping symptoms of Mania and Depression. One can observe forms of MDI where the polarity alternates from Mania to Depression, others where the presentation is consistently of the same polarity (i.e., chronic Mania/Hypomania, recurrent Depression or recurrent Mixed States).

EPIDEMIOLOGY

Manic Depressive Illness (MDI) is a common medical condition affecting approximately 6% of the population.

Index of Topics

Find an article on the internet and read the original report. Learn from the researchers the Methods used (how the research conducted and the results analysed), read the results of their research and see if you agree with their conclusions.

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Two Year Syndromal and Functional Recovery in 219 Cases of First-Episode Major Affective Disorder With Psychotic Features

Authors: Mauricio Tohen, M.D., Dr.P.H., John Hennen, Ph.D., Carlos M. Zarate, Jr., M.D., Ross J. Baldessarini, M.D., Stephen M. Strakowski, M.D., Andrew L. Stoll, M.D., Gianni L. Faedda, M.D., Trisha Suppes, M.D., Ph.D., Priscilla Gebre-Medhin, M.S., and Bruce M. Cohen, M.D., Ph.D.
Am J Psychiatry 2000; 157:220-228

Reliability and Validity of Depressive Personality Disorder

Authors: Katharine A. Phillips, M.D., John G. Gunderson, M.D., Joseph Triebwasser, M.D., Catherine R. Kimble, M.D., Gianni L. Faedda, M.D., In Kyoon Lyoo, M.D., and Jo Renn, M.A.
Am J Psychiatry 2000; 157:220-228