The game changer for 2017 in psychiatry was not ketamine, psychedelics, or rTMS–although these were excited developments, too–it was a new diagnosis, forwarded strongly by the US (the San Diego group to be exact):  MIXED DEPRESSION.

The net effect was to remarkably expand the Mood Spectrum, tease out another mimic of depression, and expertly guide our hands towards better outcomes for our mood disordered patients.

The facts around diagnosis and treatment of mixed depression are summarized by MedScape in this link, and there is an unrestricted release in Creative Commons to distribute the original guidelines, as first published by Stephen Stahl, MD, in CNS Spectrum, in Spring 2017.

My executive summary would be as follows:  mixed depression is situated between unipolar depression and bipolar mania, whereby both features are present–to some degree–simultaneously.  The implication of such a mood state cannot be overstated here:  it is an episode that is worsened by antidepressants, may lead to great agitation and even suicidality if treated with antidepressants, but responds quickly to atypical antipsychotics (seroquel, risperdal, zyprexa, zeldox, abilify, saphris, etc.) or lithium or mood stabilizers (epival, tegretol, lamictal, etc.).

We are working hard, moving forward, to make the right diagnosis; there is great enthusiasm that a new era in better psychiatric treatment is just around the corner.