The importance of depressive mixed states in suicidal behaviour

Research indicates that depressive mixed state (DMX) constitutes a very important suicide risk factor within the major affective episode. eral recently published studies demonstrated that DMX is present in one third of unipolar- and in two thirds of bipolar II major depressives, and substantially increases the risk of suicidal behaviour. Because of its nature and characteristics, this condition should be considered as part of the bipolar spectrum. The recognition and better understanding of DMX also have important implications for the recognition and prevention of suicide. The aim of this manuscript is to review the relationship between suicide attempt/completed suicide and depressive mixed state (DMX) (major depression plus 3 or more co-occurring intra-depressive non-euphoric hypomanic symptoms, which highly correspond to the well-recognised "agitated depression"). Our review establishes three important key points related to the role of depressive mixed states in suicidal behaviour: 1. In the majority of suicides, a current major mood episode is present; 2. DMX and agitated depression present a risk factor for suicidal behaviour; 3. DMX and agitated depression should be considered as bipolar spectrum. These should be taken into consideration in clinical and diagnostic work with affective disorder patients.