Mixed states are among the most underdiagnosed conditions in psychiatry, affecting roughly half of mood disorder patients. Dr. Nassir Ghaemi explains what mixed states actually are according to Kraepelinian nosology, why the DSM criteria miss the majority of cases, and how recognizing mixed features fundamentally changes treatment decisions, particularly regarding antidepressant use. Essential listening for any clinician treating mood disorders. Learn more at https://psychiatryletter.com