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......Many of us have a lot more to our depressions than "just depression" and to our manias than "just mania," and, not surprisingly, as Goodwin and Jamison point out, Kraepelin had a lot to say on this mater. Features of depression and mania have a way of colliding into what are referred to as "mixed states." Think of energized depressions or hellish manias, of mania symptoms in depression and depressive symptoms in mania. Think of irritability, road rage, mental distress. A lot of us spend a good part of our lives in states barely recognized by the DSM.
Kraepelin talked about depressive or anxious mania and excited depression, but Aretaeus turned in his homework some 1,800 years earlier in his observation that those with melancholy "could be angry without reason."
Full-blown mania mixed with full-blown depression (the only mixed state recognized by the DSM) may include perhaps 20 percent of us. But loosen the criteria to say two depressed symptoms in mania or hypomania, or two manic/hypomanic symptoms in depression and we are talking figures that range from one-third to two thirds of our population.....

"Hyperthymic" and "depressive," for example, indicate the soft end of the manic and depressed spectrums, respectively. Think of these as personality "traits" rather than illness "states." We have yet to establish causation between trait and state, which makes for some interesting theorizing. For example, can a discordance between trait and state – say an individual with a hyperthymic personality slipping into depression – account for mixed episodes?

The more I read the less I know
bizi