European Archives of Psychiatry and Clinical Neuroscience

, Volume 256, Issue 8, pp 512–515

The continuum/spectrum concept of mood disorders: is mixed depression the basic link?


DOI: 10.1007/s00406-006-0672-4

Cite this article as:
Benazzi, F. Eur Arch Psychiatry Clin Neurosci (2006) 256: 512. doi:10.1007/s00406-006-0672-4



Mixed states, i.e., opposite polarity symptoms in the same mood episode, question the bipolar/unipolar splitting of mood disorders, and support a spectrum view. Study aim was assessing the distribution of intradepressive hypomanic symptoms between bipolar-II (BP-II) and major depressive disorder (MDD) depressions, and testing a dose–response relationship between number of intradepressive hypomanic symptoms and bipolar family history. No bi-modality, and a dose–response relationship, would not support a categorical distinction.


Consecutive 389 BP-II and 261 MDD depressed outpatients were interviewed by the structured clinical interview for DSM-IV, hypomania interview guide, and family history screen, by a mood specialist psychiatrist, in a private practice. Intradepressive hypomanic symptoms were systematically assessed. Mixed depression was defined as the combination of depression and three or more intradepressive hypomanic symptoms, a validated definition.


BP-II, versus MDD, had significantly more intradepressive hypomanic symptoms. The distribution of intradepressive hypomanic symptoms between BP-II and MDD was not bi-modal but normal-like, and a dose–response relationship was found between the number of intradepressive hypomanic symptoms and bipolar family history.


Study findings question the categorical division of BP-II and MDD, and may support the spectrum view of mood disorders.


major depressive disorderbipolar II disorderspectrummixed depressiondepressive mixed state

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  1. 1.Hecker Psychiatry Research CenterForliItaly
  2. 2.University of California at San Diego Collaborating Center (USA)San DiegoUSA
  3. 3.Department of PsychiatryUniversity of SzegedSzegedHungary
  4. 4.Department of PsychiatryNational Health ServiceForliItaly
  5. 5.Castiglione di CerviaItaly