jor depressive disorder in both primary care  and specialty mental health settings. High
levels of anxiety have been associated with higher suicide risk, longer duration of ill-
ness, and greater likelihood of treatment nonresponse. As a result, it is clinically useful
to specify accurately the presence and severity levels of anxious distress for treatment
planning and monitoring of response to treatment.
With mixed features:  
A. At least three of the following manic/hypomanic symptoms are present nearly every
day during the majority of days of a major depressive episode:
1. Elevated, expansive mood.
2. Inflated self-esteem or grandiosity.
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Increase in energy or goal-directed activity (either socially, at work or school, or
sexually).