Within a major depressive episode, the specifier 'with mixed features' requires at least how many manic symptoms?

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The essential idea is that a major depressive episode can carry a mixed features specifier when some manic symptoms are also present. The threshold for this specifier is three or more manic symptoms occurring during the majority of days of the depressive episode. This cutoff helps distinguish a purely depressive state from a mixed state that suggests bipolar spectrum involvement and has implications for prognosis and treatment.

Manic symptoms that count toward this specifier include elevated or expansive mood, inflated self-esteem or grandiosity, decreased need for sleep, increased talkativeness or pressure to keep talking, racing thoughts or flight of ideas, distractibility, increased goal-directed activity or psychomotor agitation, and reckless or impulsive behavior. If three or more of these are present most days, the depressive episode is described as having mixed features.

So, the correct threshold is three or more manic symptoms during the depressive episode.