The term “mixed episode” was changed to “mixed features” in the last edition of the Diagnostic and Statistical Manual (DSM-5) published by the American Psychiatric Association in 2013. The new term may apply to either episodes of mania with additional symptoms of depression or the opposite, episodes of depression with additional symptoms of mania. The overall idea is that the presence of both mania and depression can exist at the same time. Symptoms of mania include elated mood, decreased need to sleep or racing thoughts. Symptoms of depression can include depressed mood, and feelings of hopelessness or worthlessness.