Depression, Depression Types

Mixed Episode

A Mixed Episode is characterized by a period of time in which the criteria for a Manic Episode and Major Depressive Episode are met.

The individual experiences rapidly changing moods (sadness, euphoria, irritability) accompanied by symptoms that fall unto the above mentioned disorders.

The disturbance must be severe enough as to cause impairment in social and occupational functioning.

Individuals may be disorganized in their thinking or behavior.

Mixed Episodes may last up to weeks or months and may remit to a phase of few or no symptoms at all.

The disorder can evolve from Manic Episode or MDE.

Criteria for Mixed Episode

A. See criteria for Manic Episode and Major Depressive Episode.

B. The mood disturbance us sufficiently severe to cause marked impairment in occupational functioning, or one that requires hospitalization to prevent harm from self or to others.

C. The symptoms are not due to the direct physiological effects of a substance.


In the DSM, there is a section in the Mood Disorder section that is called specifiers.

Specifiers are a way to further categorize the major disorders to further diagnostic capabilities in addition to help describe the current type of episode or disorder with particular features, or, specifiers.


No more than minimum symptom criteria are met for both Manic Episode and Major Depressive Episode.


Symptoms or functional impairment between “mild” and “severe”.

Severe Without Psychotic Features:

Almost continual supervision is required to prevent physical harm to self or others.

Severe With Psychotic Features:

Delusions or hallucinations. If possible specify whether the psychotic dentures are mood-congruent or mood-incongruent.

Mood-Congruent Psychotic Features: Delusions or hallucinations whose content is entirely consistent with the typical manic or depressive themes.

Mood-Incongruent Psychotic Features: Delusions and hallucinations whose content does not involve typical manic or depressive themes. Included are such symptoms as persecutory delusions (not directly related to grandiose ideas or themes), thought insertion, and delusions of being controlled.

In Partial Remission:

Symptoms of a Mixed Episode are present but full criteria are not met, or there is a period without ant significant symptoms of a Mixed Episode lasting less than 2 months following the end of the Mixed Episode.

In Full Remission:

During the past 2 months, no significant signs or symptoms of the disturbance were present.