Mixed, melancholic, and anxious features in depression: A cross-sectional study of sociodemographic and clinical correlates

Leonardo Zaninotto, Daniel Souery, Raffaella Calati, Paolo Scudellari, Luigi Janiri, Stuart Montgomery, Siegfried Kasper, Joseph Zohar, Julien Mendlewicz, Alessandro Serretti*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Major depression (MD) is currently viewed as a heterogeneous condition, characterized by different psychopathological dimensions. METHODS: Our sample was composed of 1,289 nonpsychotic bipolar/unipolar depressed patients. Participants were divided into mixed (MXD), melancholic (MEL), and anxious (ANX) depressed, according to a hierarchical functional model. Sociodemographic and clinical variables were compared across depressive subtypes by χ2 test and analysis of variance. The Young Mania Rating Scale (YMRS) and 2 subscales (melancholic [MEL-S] and psychic-somatic anxiety [PSOM-ANX]) from the Hamilton Depression Rating Scale also served as continuous outcome measures. RESULTS: MXD patients more frequently had bipolar I disorder (BD I), younger age of onset, and a higher familial load for mood disorders. MEL and ANX patients were more frequently diagnosed with major depressive disorder and reported a higher suicide risk. YMRS scores in depression were associated with BD I diagnosis (P < .0001) and manic polarity of the last episode (P < .0001), while a depressive polarity of the last episode (P < .0001) was associated with higher MEL-S score. No specific predictor was associated with PSOM-ANX score. CONCLUSIONS: Overall, our findings suggest that mixed depressive features are associated with significant hallmarks of bipolarity, and melancholic features may be influenced by previous depressive polarity. The symptom domain of anxiety appears to have no specific predictor.

Original languageEnglish
Pages (from-to)243-253
Number of pages11
JournalAnnals of Clinical Psychiatry
Issue number4
StatePublished - 1 Nov 2014
Externally publishedYes


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