One Size Does Not Fit All: Optimizing Use of Major Depressive Disorder Specifiers to Improve Outcomes
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Major depressive disorder (MDD) is a highly heterogeneous disorder that is increasingly seen as a continuum, with emphasis on overlapping and subthreshold symptoms. To address this issue, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included the use of specifiers, such as mixed features and anxious distress, with the diagnosis of MDD. Although DSM-5 specifiers improve utility and precision in the diagnosis of MDD and related disorders, they may not be widely adopted because some clinicians maintain a categorical approach toward depression. The risk when clinicians avoid specifiers is significant because patients with diverse depressive illnesses should be diagnosed, monitored, and treated differently. Further, compared with MDD alone, the presence of mixed features or anxious distress in patients with MDD may be associated with diminished response to antidepressants, more severe symptoms, increased hospitalization, greater risk for suicide, and other deleterious outcomes. It is important for health care providers to appreciate the importance of MDD specifiers, their diagnostic criteria, and implications for evidence-based treatment. This activity was created to enhance knowledge and competence of health care providers who evaluate and manage patients with depression and clinical features of hypomania, mania, or anxiety.