Valentí M et al. – The occurrence of mixed episodes is associated with a tendency to chronicity, with a poorer outcome, a higher number of depressive episodes, and greater use of antidepressants, especially serotonin norepinephrine reuptake inhibitors

• 144 patients followed for up to 20 years in the referral Barcelona Bipolar Disorder Program
• Compared subjects who had experienced at least 1 mixed episode during follow-up (n = 60) with subjects who had never experienced mixed episode (n = 84) regarding clinical variables

• Nearly 40% of bipolar I disorder patients treated with antidepressants experienced at least one mixed episode during the course of their illness; no gender differences were found between two groups
• After performing logistic regression analysis, only suicide attempts , use of serotonin norepinephrine reuptake inhibitors , switch rates , and years spent ill significantly associated with occurrence of at least 1 mixed episode during follow-up