PSYCHOTIC DEPRESSION

The presence of delusions or hallucinations in major depressive disord er indicates a severe form of that disorder. Compared with patients wi th nonpsychotic depression, those with psychotic depression have depre ssive symptoms that are individually more. severe. They also are more likely to have hypothalamic-pituitary adrenal axis hyperactivity and i ncreased ventricular-to-brain ratios. The short- and long-term outcome s for such patients are poor. Findings that this prognostic disadvanta ge may be permanent and that psychotic features recur at high rates in subsequent episodes indicate that these symptoms in major depressive disorder have a lifelong significance. Although monotherapy with antid epressants may be effective, recovery is more rapid when antidepressan ts are combined with antipsychotics. Electroconvulsive therapy is part icularly effective for psychotic depression. The importance of combina tion therapy for prophylaxis is unknown.