The Treatment of Psychotic Depression

Psychotic depression is marked by increased severity, longer episodes, greater incapacity, and alower likelihood of placebo response. Psychotic features often recur in subsequent episodes andinterepisode intervals are shorter when psychotic features have been previously present. Among thetreatment options for psychotic depression, electroconvulsive therapy is particularly effective. Conventionalpharmacotherapy consists of tricyclic antidepressants combined with antipsychotics; recoverywith tricyclic antidepressant monotherapy is less likely. Serotonin selective reuptake inhibitorsmay prove useful but the relevant literature is scant. Pharmacokinetic interactions are likely in combinationtreatment, as are side effects that may mimic the underlying condition. Little is known regardingthe importance of antipsychotics to maintenance therapy.