Am J Psychiatry 1993; 150:1548-1551
Copyright © 1993 by American Psychiatric Association

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Depressive mania associated with nonresponse to antimanic agents

SC Dilsaver, AC Swann, AM Shoaib, TC Bowers and MT Halle
Harris County Psychiatric Center, Department of Psychiatry and Behavioral Sciences, University of Texas School of Medicine, Houston 77021.

Of 39 patients consecutively admitted for the treatment of primary mania, 21 (53.8%) simultaneously met the Research Diagnostic Criteria for major depressive disorder ("mixed" or "depressive" mania). Only nine (42.9%) of the 21 patients with depressive mania responded to antimanic agents. In contrast, 16 (88.9%) of the 18 patients with pure mania responded to these drugs. This finding is consistent with previous reports suggesting that the mixed state is a virulent form of mania.

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