The treatment of psychotic depression

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