One Size Does Not Fit All: Optimizing Use of Major Depressive Disorder Specifiers to Improve Outcomes

This activity has been designed to address the educational needs of psychiatrists and other mental health care professionals who manage patients with major depressive disorder.

Supported by educational grants from:

Otsuka America Pharmaceutical Inc. and Lundbeck 

Activity Information


Release date: September 10, 2019
Valid through: September 10, 2020
Estimated time to complete activity: 90 minutes



Statement of Need/Program Overview

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.

Learning Goal/Purpose

The goal of this activity is to educate health care professionals to use mixed features and anxious distress specifiers of the DSM-5 as tools to evaluate and expertly manage patients with depression who have relevant clinical features of mania and anxiety.

Educational Objectives

After completing this activity, the participant should be better able to:

  • Discuss integrated dimensional approaches to depression in the DSM-5 and the need for new MDD specifiers  
  • Implement strategies to enhance the recognition, diagnosis, and management of MDD with mixed features
  • Optimize the screening, diagnosis, and management of patients with depression and anxious distress


Michael E. Thase, MD
Professor of Psychiatry
Department of Psychiatry
Perelman School of Medicine - University of Pennsylvania
Michael J. Crescenz VAMC
Philadelphia, Pennsylvania

Physician Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Medical Education Resources (MER) and CMEology. MER is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

Medical Education Resources designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Credit

Medical Education Resources is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This CE activity provides 1.5 contact hours of continuing nursing education.  Medical Education Resources is a provider of continuing nursing education by the California Board of Registered Nursing, Provider #CEP 12299.

Disclosure of Conflicts of Interest

Medical Education Resources (MER) ensures balance, independence, objectivity, and scientific rigor in all our educational programs. In accordance with this policy, MER identifies conflicts of interest with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Conflicts are resolved by MER to ensure that all scientific research referred to, reported, or used in a continuing education activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing its learners with high-quality activities that promote improvements or quality in health care and not the business interest of a commercial interest.

The faculty reported the following financial relationships with commercial interests whose products or services may be mentioned in this activity:

Michael E. Thase, MD
Reported Financial Relationships
Consultant/Advisor for Acadia Pharmaceuticals Inc., Akili, Alkermes PLC, Allergan, Inc. (Forest, Naurex), Cerecor, Inc., Fabre-Kramer Pharmaceuticals, Inc., Gerson Lehrman Group, Inc., Guidepoint Global, LLC, Johnson & Johnson (Janssen, Ortho-McNeil), Lundbeck, moksha8 Pharmaceuticals, Inc., Nestlé (Pamlab), Neuralstem, Inc., Novartis International AG, Otsuka Pharmaceutical Company, Ltd., Pfizer, Inc., Sage Therapeutics, Sunovion Pharmaceuticals Inc.; Research/Grant Support from Acadia Pharmaceuticals Inc., Agency for Healthcare Research and Quality (AHRQ), Alkermes PLC, Allergan, Inc. (Forest, Naurex), AssureRx Health, Inc., Avanir Pharmaceuticals, Inc., Axsome Therapeutics, Inc., Intracellular Therapies, Janssen Pharmaceuticals, Inc., Johnson & Johnson (Janssen, Ortho-McNeil), National Institutes of Health/National Institute of Mental Health (NIMH), Otsuka Pharmaceutical Company, Ltd., Patient-Centered Outcomes Research Institute (PCORI), Takeda Pharmaceutical Company

The content managers reported the following financial relationships with commercial interests whose products or services may be mentioned in this activity:

Rob Lowney (CMEology)
No financial relationships to disclose.

Dana Ravyn, PhD, MPH (CMEology)
No financial relationships to disclose.

Beth Goodwin (CMEology)
No financial relationships to disclose.

MER content reviewers
No financial relationships to disclose.

Method of Participation

There are no fees for participating in and receiving credit for this activity. During the period TBD through TBD, participants must 1) read the learning objectives and faculty disclosures, 2) study the educational activity, 3) complete the posttest by recording the best answer to each question, and 4) complete the evaluation form.

A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better, with no more than 3 attempts.


The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Medical Education Resources, CMEology, and/or Otsuka America Pharmaceutical, Inc. and Lundbeck. The authors have disclosed if there is any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. Before prescribing any medicine, primary references and full prescribing information should be consulted. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management.

Fee Information

There is no fee for this educational activity.

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