Psychotic Depression

Primer

Psychotic Depression (also known as Major Depressive Disorder with psychotic features in the DSM-5) is a subtype of depression characterized by psychosis (delusions, hallucinations) in addition to mood changes. It requires the treatment of the underlying mood disorder first to resolve the psychosis.

Treatment

  • For psychotic depression, treatment with an antidepressant-antipsychotic combination is better than treating with an antidepressant or antipsychotic alone.[1] For example, treatment with olanzapine plus sertraline has been shown to be efficacious.[2] It remains uncertain how long one should remain on this combination treatment once the psychotic depressive episode has remitted.

Resources

References

1) Kennedy, S. H., Lam, R. W., McIntyre, R. S., Tourjman, S. V., Bhat, V., Blier, P., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. Pharmacological treatments. The Canadian Journal of Psychiatry, 61(9), 540-560.
2) Meyers, B. S., Flint, A. J., Rothschild, A. J., Mulsant, B. H., Whyte, E. M., Peasley-Miklus, C., ... & Heo, M. (2009). A double-blind randomized controlled trial of olanzapine plus sertraline vs olanzapine plus placebo for psychotic depression: the study of pharmacotherapy of psychotic depression (STOP-PD). Archives of general psychiatry, 66(8), 838-847.