{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:23:58Z","timestamp":1790843038770,"version":"4.1.0"},"reference-count":49,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"unspecified","delay-in-days":279,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2019YFA0706200"],"award-info":[{"award-number":["2019YFA0706200"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82201693"],"award-info":[{"award-number":["82201693"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2022JJ40701"],"award-info":[{"award-number":["2022JJ40701"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S0033291725101955_sec1\">\n\t    <jats:title>Background<\/jats:title>\n\t    <jats:p>With the increased prevalence of major depressive episodes with mixed features specifier (MDE-MFS), the pharmacological treatment for MDE-MFS has attracted great clinical attention. This study aimed to investigate the efficacy and safety of medication use for MDE-MFS.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0033291725101955_sec2\" sec-type=\"methods\">\n\t    <jats:title>Methods<\/jats:title>\n\t    <jats:p>Commonly used databases were searched for the meta-analysis. Primary efficacy outcomes included response rate and the change in the Young Mania Rating Scale scores; the primary safety outcome was the rate of treatment-emergent hypomania\/mania. Effects were expressed as relative risk (RR) or standardized mean difference (SMD).<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0033291725101955_sec3\" sec-type=\"results\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>In patients with MDE-MFS, antipsychotics significantly improved depressive (RR\u00a0=\u00a01.46 [95% CI: 1.31, 1.61]) and manic (SMD\u00a0=\u00a0\u22120.35 [95% CI: \u22120.53, \u22120.17]) symptoms without increasing the risk of manic switch (RR\u00a0=\u00a00.91 [95% CI: 0.53, 1.55]). However, subgroup analysis of bipolar disorder (BD) patients with MDE-MFS indicated that antipsychotics had limited effects on manic symptoms. Mood stabilizers, especially valproate, demonstrated significant effects in BD patients with MDE-MFS by relieving depressive and manic symptoms. For MDE-MFS in patients with major depressive disorder, trazodone has shown potential effectiveness in retrospective studies, while the effectiveness of antidepressants on BD patients with MDE-MFS lacked evidence.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S0033291725101955_sec4\" sec-type=\"conclusions\">\n\t    <jats:title>Conclusions<\/jats:title>\n\t    <jats:p>While antipsychotics are first options for MDE-MFS, their effect on manic symptoms in BD patients with MDE-MFS is still unclear. Mood stabilizers may also be considered, and the use of antidepressants remains a topic of controversy. Since our findings are mostly based on post-hoc analyses, the evidence remains preliminary, highlighting the need for further research to produce more conclusive evidence.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s0033291725101955","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T08:14:35Z","timestamp":1759824875000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["The efficacy and safety of pharmacological treatment for major depressive episode with mixed features specifier: a systematic review and meta-analysis"],"prefix":"10.1017","volume":"55","author":[{"given":"Sirui","family":"Gao","sequence":"first","affiliation":[{"name":"The Second Xiangya Hospital of Central South University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjun","family":"Chen","sequence":"additional","affiliation":[{"name":"The Second Xiangya Hospital of Central South 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