W. Clay Jackson, MD, on Approaches for Treating Major Depressive Disorder With Mixed Features

W. Clay Jackson, MD, DipTh, discusses treatment approaches for major depressive disorder (MDD) with mixed features, after his Psych Congress 2019 presentation "Clinical Challenges in MDD: Addressing the Needs of Patients with Comorbid Disorders" with Psych Congress cochairs Rakesh Jain, MD, MPH, and Charles Raison, MD.

Additional Resources:


Considering Lithium as a Treatment for Depression

Examining Comorbidities in Patients With Depression

The Biopsychosocial Model of Sexual Response

Dr. Jackson is a Clinical Assistant Professor of Family Medicine and Psychiatry at the University of Tennessee College of Medicine in Memphis, maintains a private practice in family medicine, and directs the palliative medicine program at the West Cancer Center in Arlington, Tennessee.


There are recent guidelines published in Florida regarding how we might treat patients with MDD with mixed features. One strategy, at first line, is to treat with an antidepressant. Another would be to treat with an atypical antipsychotic. Another would be to treat with a mood stabilizer, such as what we used to call the anticonvulsant class.

If treatment fails, however, combination therapy may be appropriate. Basically, you can look at the antidepressant, the mood stabilizer, and the atypical antipsychotic. We pick 2 out of 3 and combine those together to achieve treatment.

What we're basically looking for is an agent to add with an antidepressant that might provide mood stabilizing qualities or sometimes we just go with the atypical antipsychotic and the anticonvulsive and leave out the antidepressant entirely.

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