THE TREATMENT OF PSYCHOTIC DEPRESSION

Psychotic depression is marked by increased severity, longer episodes, greater incapacity, and a lower likelihood of placebo response. Psych otic features often recur in subsequent episodes and interepisode inte rvals are shorter when psychotic features have been previously present . Among the treatment options for psychotic depression, electroconvuls ive therapy is particularly effective. Conventional pharmacotherapy co nsists of tricyclic antidepressants combined with antipsychotics; reco very with tricyclic antidepressant monotherapy is less likely. Seroton in selective reuptake inhibitors may prove useful but the relevant lit erature is scant. Pharmacokinetic interactions are likely in combinati on treatment, as are side effects that may mimic the underlying condit ion. Little is known regarding the importance of antipsychotics to mai ntenance therapy.