It is well established that mixed features are a common presentation in bipolar disorder (BD).1 It is also previously reported that subthreshold depressive symptoms are common during hypomania and differentially affect female patients.2 Moreover, individuals with mixed features are more likely to present with greater illness complexity, higher rates of chronicity and non-recovery, as well as a less favourable course of illness.3 To read the full article, log in using your NHS OpenAthens details.