Agitated psychotic depression associated with severe hypomanic episodes: a rare syndrome

The authors present detailed clinical and follow-up data on 12 patients with agitated psychotic depressions who developed serious hypomanic or manic episodes. In six patients, each type of affective episode seemed to merge into the others, while in the other patients there was always a clear temporal distinction between each type of episode. The authors suggest that the older ages of their patients may have contributed to the syndrome. They also offer several possible theoretical explanations: the patients 1) had mixed affective states and were trapped in the "switch" state from depression to mania, 2) inherited both unipolar and bipolar diseases, 3) represent a subgroup of bipolar patients, and 4) were schizoaffective.