LOW USE OF NEUROLEPTIC DRUGS IN THE TREATMENT OF PSYCHOTIC MAJOR DEPRESSION

Objective: The adequacy of pharmacologic treatment received by patient s with psychotic major depression was evaluated. Method: The authors s ystematically assessed the pharmacotherapy received by 187 depressed p atients before initiation of ECT and compared the medication trials of those with psychotic (N=53) and nonpsychotic (N=134) depression. Resu lts: Despite a median of four medication trials and median index episo de duration of 20 weeks, only two (4%) of the patients with psychotic depression received at least one adequate pharmacotherapy trial. In co ntrast, 70 (52%) of the patients with nonpsychotic depression received at least one adequate trial. Twenty-five (47%) of the patients with p sychotic depression received either no neuroleptic treatment (N=11) or treatment for less than 3 weeks (N=14). Only eight (15%) received a d aily neuroleptic dose higher than 200 mg of chlorpromazine equivalents . Conclusions: These findings suggest that many patients with psychoti c major depression referred for ECT receive inadequate pharmacotherapy because of either the absence or the inadequate use of neuroleptic me dication.