Materiały źródłowe

• #1 Depression with psychosis: Symptoms, treatment, and recoveryMedical News Today

  https://www.medicalnewstoday.com/articles/323193

  Depression with psychotic features is when someone experiences both depression and psychosis. Psychosis refers to a disconnection from reality. […] Major depression with psychotic features is also sometimes referred to as psychotic depression. It is a grave illness characterized by a combination of unipolar major depressive symptoms and psychosis. […] This form of depression is an underdiagnosed and undertreated condition. […] This article will discuss how specialists diagnose depression with psychosis, as well as outlining treatment options and steps to recovery. […] Depression with psychosis is when a person has depression and also experiences a disconnection from reality, which is called psychosis. […] Experts also refer to depression with psychosis as depression with psychotic features.

• #2 Major depression with psychotic features – UF Health

  https://ufhealth.org/conditions-and-treatments/major-depression-with-psychotic-features

  Major depression with psychotic features is a mental disorder in which a person has depression along with loss of touch with reality (psychosis). […] Psychotic depression requires immediate medical care and treatment. […] Treatment usually involves antidepressant and antipsychotic medicine. You may only need antipsychotic medicine for a short period of time. […] Electroconvulsive therapy can help treat depression with psychotic symptoms. However, medicine is usually tried first. […] This is a serious condition. You will need immediate treatment and close monitoring by a provider. […] You may need to take medicine for a long time to prevent the depression from coming back. Depression symptoms are more likely to return than psychotic symptoms. […] The risk for suicide is much higher in people with depression with psychotic symptoms than in those without psychosis.

• #3 Psychotic Depression Can Be Effectively Treated but is Often Tragically Missed | Brain & Behavior Research Foundation

  https://bbrfoundation.org/content/psychotic-depression-can-be-effectively-treated-often-tragically-missed

  Psychotic depression, which is major depressive disorder combined with psychotic delusions or hallucinations, often goes undiagnosed. […] Two treatments are recommended for treating psychotic depression: an antipsychotic medication combined with an antidepressant or electroconvulsive therapy (ECT). […] The irony is that despite the severity of the disorder, these patients can actually achieve complete relief when appropriately treated.

• #4 Depressive Psychosis: Causes, Symptoms, and DiagnosisHealthline

  https://www.healthline.com/health/depression/major-depression-with-psychotic-features

  According to the National Alliance on Mental Illness (NAMI), an estimated 20 percent of people who have major depression also have psychotic symptoms. This combination is known as depressive psychosis. […] Currently, there are no treatments specifically for depressive psychosis that are approved by the FDA. There are treatments for depression and psychosis, but there aren’t any specifically for people who have both of these conditions at the same time. […] Your doctor may treat you for this condition or refer you to a licensed mental health professional who specializes in the use of medications for these conditions. […] Mental health providers may prescribe a combination of antidepressants and antipsychotics. […] The second treatment option is electroconvulsive therapy (ECT). […] Your psychiatrist can discuss these options with you and your family to determine the best course of treatment for your condition. […] Living with depressive psychosis can feel like a constant battle. Even if your symptoms are under control, you may be concerned they’ll come back. Many people also choose to seek psychotherapy to manage symptoms and overcome fears.

• #5 Psychotic Depression Can Be Effectively Treated but is Often Tragically Missed | Brain & Behavior Research Foundation

  https://bbrfoundation.org/content/psychotic-depression-can-be-effectively-treated-often-tragically-missed

  Psychotic depression, which is major depressive disorder combined with psychotic delusions or hallucinations, often goes undiagnosed. […] Two treatments are recommended for treating psychotic depression: an antipsychotic medication combined with an antidepressant or electroconvulsive therapy (ECT). […] The irony is that despite the severity of the disorder, these patients can actually achieve complete relief when appropriately treated.

• #6 Psychotic depression – NHS

  https://www.nhs.uk/mental-health/conditions/psychotic-depression/

  Treatment for psychotic depression involves: […] a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis […] the 1-to-1 talking therapy cognitive behavioural therapy (CBT) has proved effective in helping some people with severe depression, including those with psychosis […] support with social needs, such as education, employment or accommodation. […] Electroconvulsive therapy (ECT) may sometimes be recommended if the person has severe depression and other treatments, including antidepressants, have not worked. […] Treatment is usually effective, but follow-up appointments so that the person can be closely monitored are usually required.

• #7 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  I have a patient with psychotic depression (major depression with psychotic features). Can I treat her with medications? […] The American Psychiatric Association (APA) practice guidelines recommend with substantial clinical confidence (the highest ranking) that patients with psychotic depression be treated with the combination of an antidepressant and an antipsychotic or electroconvulsive therapy (ECT) […] In the United States, despite the APA practice guideline recommending the combination of an antidepressant and antipsychotic for the acute treatment of psychotic depression since 2000, studies have shown that only 5% of patients with psychotic depression receive an adequate combination of an antidepressant and an antipsychotic […] Efficacy has been demonstrated for only certain specific combinations of an antidepressant and antipsychotic; thus, whether the combinations discussed below are generalizable to all patients with psychotic depression or all combinations of antidepressant and antipsychotic medications is not known.

• #8 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  I have a patient with psychotic depression (major depression with psychotic features). Can I treat her with medications? […] The American Psychiatric Association (APA) practice guidelines recommend with substantial clinical confidence (the highest ranking) that patients with psychotic depression be treated with the combination of an antidepressant and an antipsychotic or electroconvulsive therapy (ECT) […] In the United States, despite the APA practice guideline recommending the combination of an antidepressant and antipsychotic for the acute treatment of psychotic depression since 2000, studies have shown that only 5% of patients with psychotic depression receive an adequate combination of an antidepressant and an antipsychotic […] Efficacy has been demonstrated for only certain specific combinations of an antidepressant and antipsychotic; thus, whether the combinations discussed below are generalizable to all patients with psychotic depression or all combinations of antidepressant and antipsychotic medications is not known.

• #9 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  I have a patient with psychotic depression (major depression with psychotic features). Can I treat her with medications? […] The American Psychiatric Association (APA) practice guidelines recommend with substantial clinical confidence (the highest ranking) that patients with psychotic depression be treated with the combination of an antidepressant and an antipsychotic or electroconvulsive therapy (ECT) […] In the United States, despite the APA practice guideline recommending the combination of an antidepressant and antipsychotic for the acute treatment of psychotic depression since 2000, studies have shown that only 5% of patients with psychotic depression receive an adequate combination of an antidepressant and an antipsychotic […] Efficacy has been demonstrated for only certain specific combinations of an antidepressant and antipsychotic; thus, whether the combinations discussed below are generalizable to all patients with psychotic depression or all combinations of antidepressant and antipsychotic medications is not known.

• #10 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #11 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #12 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #13 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #14 The best drug treatment for psychotic depression: Antidepressants, antipsychotics or both combined? Commentary On… Cochrane Corner | BJPsych Advances | Cambridge Core

  https://www.cambridge.org/core/journals/bjpsych-advances/article/best-drug-treatment-for-psychotic-depression-antidepressants-antipsychotics-or-both-combined-commentary-on-cochrane-corner/AFCF12F304391C14F97796BBB919C9B7

  Psychotic depression is a severe condition. Drug treatment (antipsychotics, antidepressants or the combination) or electroconvulsive therapy (ECT) are both effective. However, a 2005 Cochrane review of drug treatments could not find a clear benefit for combination treatment with antidepressant and antipsychotic medication over antidepressants alone. The current updated Cochrane review (2015) incorporated two larger studies and found evidence of superiority for combination treatment. Both pharmacotherapy and electroconvulsive therapy (ECT) are recommended as first-line treatments for psychotic depression, and where pharmacotherapy is used, these guidelines recommend a combination of an antidepressant and an antipsychotic. The traditional view is that antidepressants treat depressive symptoms and antipsychotics treat psychotic symptoms, implying that a combination of both drugs is needed to treat psychotic depression effectively. An alternative view is that psychotic depression is at the severe end of a continuum of depressive illness, implying that adequate antidepressant treatment alone might be equally effective. The review found that the combination of an antidepressant plus an antipsychotic is more effective in psychotic depression than antidepressant monotherapy, antipsychotic monotherapy or placebo. The limited evidence available also shows no benefit of antipsychotic alone or antidepressant alone over placebo. This review gives clear evidence that combination treatment should be used as first-line therapy where pharmacological treatment is considered. […] However, it was not able to answer some key questions. These include assessing the relative merits of antipsychotics and/or antidepressants v. ECT or ketamine in acute treatment, and which treatments are best for long-term maintenance and prevention of recurrence.

• #15 Pharmacological treatment for psychotic depression | Cochrane

  https://www.cochrane.org/CD004044/DEPRESSN_pharmacological-treatment-psychotic-depression

  Psychotic depression is a severe depression with psychotic features (i.e. delusions and/or hallucinations). Uncertainty surrounds the most effective drug treatment for psychotic depression: an antidepressant alone, an antipsychotic alone, or the combination of an antidepressant plus an antipsychotic. […] From these trials, we found evidence that the combination of an antidepressant plus an antipsychotic provides more effective treatment for psychotic depression than either treatment alone. […] Some evidence indicates that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or placebo. […] Evidence is limited regarding the most effective pharmacological treatment for psychotic depression: monotherapy with an antidepressant, monotherapy with an antipsychotic, another treatment (e.g. mifepristone), or combination of an antidepressant plus an antipsychotic.

• #16 Pharmacologic Treatment of Psychotic Depression | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0601/p1935.html

  What is the best treatment for depression with psychotic features? […] An antidepressant such as imipramine (Tofranil) or sertraline (Zoloft), possibly with the addition of an antipsychotic, is the preferred initial pharmacologic treatment for psychotic depression. […] Electroconvulsive therapy often is used to treat psychotic depression and has been shown to be effective in comparisons with sham electroconvulsive therapy. Typically, however, it is not considered first-line therapy, and it has not been compared with pharmacologic treatment in a randomized controlled trial (RCT). […] The authors found that an antidepressant alone was effective (four RCTs; relative risk [RR] 2.06; 95% confidence interval [CI], 1.41 to 3.00), but an antipsychotic alone was not. […] Based on these limited data, the preferred initial agents are imipramine and sertraline. […] An important practice point for these patients that was not addressed by this meta-analysis is that they should be strongly considered for hospitalization.

• #17 Psychotic Depression: Symptoms, Causes, Diagnosis, and Treatment

  https://www.verywellmind.com/psychotic-depression-1066607

  Psychotic depression involves having symptoms of severe depression along with psychosis. This condition involves the usual symptoms of depression, such as depressed mood, appetite changes, and loss of interest in activities previously enjoyed. […] Treatments that may help include medications and electroconvulsive therapy. […] The American Psychiatric Association (APA) recommends either the combination of an antidepressant and antipsychotic or electroconvulsive therapy (ECT) as the first-line treatment for psychotic depression. […] Evidence suggests that combination therapy with an antidepressant such as an SSRI or SNRI plus an antipsychotic is more effective than either of the two medications alone. […] Electroconvulsive therapy (ECT) is a safe and highly effective treatment for people with psychotic depression who do not respond to traditional medications. Because ECT provides such rapid relief, it is also recommended for those struggling with suicidal thoughts.

• #18 Pharmacologic Treatment of Psychotic Depression | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0601/p1935.html

  What is the best treatment for depression with psychotic features? […] An antidepressant such as imipramine (Tofranil) or sertraline (Zoloft), possibly with the addition of an antipsychotic, is the preferred initial pharmacologic treatment for psychotic depression. […] Electroconvulsive therapy often is used to treat psychotic depression and has been shown to be effective in comparisons with sham electroconvulsive therapy. Typically, however, it is not considered first-line therapy, and it has not been compared with pharmacologic treatment in a randomized controlled trial (RCT). […] The authors found that an antidepressant alone was effective (four RCTs; relative risk [RR] 2.06; 95% confidence interval [CI], 1.41 to 3.00), but an antipsychotic alone was not. […] Based on these limited data, the preferred initial agents are imipramine and sertraline. […] An important practice point for these patients that was not addressed by this meta-analysis is that they should be strongly considered for hospitalization.

• #19 Stanford researchers study controversial drug as treatment for psychotic major depression | News Center

  https://med.stanford.edu/news/all-news/2002/08/stanford-researchers-study-controversial-drug-as-treatment-for-psychotic-major-depression.html

  Sufferers of psychotic major depression, a severe and debilitating form of mental illness, improve slowly or not at all with standard medication. […] Researchers at Stanford University Medical Center have used the drug mifepristone, also known as RU-486, to treat these patients quickly and effectively. […] The treatment is potentially controversial because mifepristone is widely known as a drug that induces abortions. […] Researchers have learned, however, that certain properties of the drug that lead to pregnancy termination can also help treat psychotic major depression. […] Antidepressant medications alone are usually ineffective for these patients, and combining antidepressants with antipsychotic drugs improve symptoms for only about 60 percent of them. […] In the study, 30 patients received either a low, medium or high dose of mifepristone, each day for a week in addition to their standard medications.

• #20 Psychotic depression – NHS

  https://www.nhs.uk/mental-health/conditions/psychotic-depression/

  Treatment for psychotic depression involves: […] a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis […] the 1-to-1 talking therapy cognitive behavioural therapy (CBT) has proved effective in helping some people with severe depression, including those with psychosis […] support with social needs, such as education, employment or accommodation. […] Electroconvulsive therapy (ECT) may sometimes be recommended if the person has severe depression and other treatments, including antidepressants, have not worked. […] Treatment is usually effective, but follow-up appointments so that the person can be closely monitored are usually required.

• #21 Psychotic Depression: What Is It, Symptoms, Causes, and MoreHealthline

  https://www.healthline.com/health/depression/psychotic-depression

  Major depressive disorder with psychosis may cause symptoms including hallucinations or delusions during a depressive episode. Treatment may include medication and other forms of therapy. […] Psychotic depression refers to major depressive disorder (MDD) with features of psychosis, a specific presentation of depression. It involves symptoms of psychosis during an episode of depression. […] Treatment for psychotic depression generally involves psychotropic medications, though you have other options, too. […] Typically, medication treatment involves a combination of antidepressants and antipsychotics. These medications help balance neurotransmitters in the brain. […] Your care team may also recommend ECT for severe depression that doesn’t respond to medication or therapy. […] While therapy alone may not do much to improve symptoms of psychosis on its own, it can still have benefit as a supportive approach. […] A therapist can also teach strategies for coping with hallucinations and delusions. Possible approaches include cognitive behavioral therapy, acceptance and commitment therapy, behavioral activation, and acceptance-based depression and psychosis therapy.

• #22 Psychotic Depression: What Is It, Symptoms, Causes, and MoreHealthline

  https://www.healthline.com/health/depression/psychotic-depression

  Major depressive disorder with psychosis may cause symptoms including hallucinations or delusions during a depressive episode. Treatment may include medication and other forms of therapy. […] Psychotic depression refers to major depressive disorder (MDD) with features of psychosis, a specific presentation of depression. It involves symptoms of psychosis during an episode of depression. […] Treatment for psychotic depression generally involves psychotropic medications, though you have other options, too. […] Typically, medication treatment involves a combination of antidepressants and antipsychotics. These medications help balance neurotransmitters in the brain. […] Your care team may also recommend ECT for severe depression that doesn’t respond to medication or therapy. […] While therapy alone may not do much to improve symptoms of psychosis on its own, it can still have benefit as a supportive approach. […] A therapist can also teach strategies for coping with hallucinations and delusions. Possible approaches include cognitive behavioral therapy, acceptance and commitment therapy, behavioral activation, and acceptance-based depression and psychosis therapy.

• #23 Combination Therapy of SSRIs and SGAs Is Optimal for Psychotic Depression – Psychiatry Advisor

  https://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/psychotic-depression-treatment/

  These findings provide specific recommendations for the most efficacious psychotic depression treatment options. […] The combination of a selective serotonin reuptake inhibitor (SSRI) and a second-generation antipsychotic (SGA) may be the most effective psychotic depression treatment approach, according to results from a systematic review and meta-analysis published in Lancet Psychiatry. […] The current study aimed to address this research gap through a network meta-analysis to determine the efficacy of pharmacological treatments for psychotic depression, contributing to a more comprehensive understanding of treatment options. […] Relative to placebo, the investigators found that only the combination of SSRIs plus SGAs was associated with a higher proportion of participants with a treatment response (risk ratio [RR] 1.89; 95% CI, 1.17-3.04).

• #24 Combination Therapy of SSRIs and SGAs Is Optimal for Psychotic Depression – Psychiatry Advisor

  https://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/psychotic-depression-treatment/

  These findings provide specific recommendations for the most efficacious psychotic depression treatment options. […] The combination of a selective serotonin reuptake inhibitor (SSRI) and a second-generation antipsychotic (SGA) may be the most effective psychotic depression treatment approach, according to results from a systematic review and meta-analysis published in Lancet Psychiatry. […] The current study aimed to address this research gap through a network meta-analysis to determine the efficacy of pharmacological treatments for psychotic depression, contributing to a more comprehensive understanding of treatment options. […] Relative to placebo, the investigators found that only the combination of SSRIs plus SGAs was associated with a higher proportion of participants with a treatment response (risk ratio [RR] 1.89; 95% CI, 1.17-3.04).

• #25 Combination Therapy of SSRIs and SGAs Is Optimal for Psychotic Depression – Psychiatry Advisor

  https://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/psychotic-depression-treatment/

  These findings suggest that the combination of an SSRI plus an SGA may be the most optimal and effective treatment option for patients with psychotic depression. […] This expansion of evidence for the pharmacological treatment of psychotic depression should improve clinical care, facilitate the development of treatment guidelines, and provide valuable insights for future clinical research, which remains insufficiently developed.

• #26 Combination Therapy of SSRIs and SGAs Is Optimal for Psychotic Depression – Psychiatry Advisor

  https://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/psychotic-depression-treatment/

  These findings suggest that the combination of an SSRI plus an SGA may be the most optimal and effective treatment option for patients with psychotic depression. […] This expansion of evidence for the pharmacological treatment of psychotic depression should improve clinical care, facilitate the development of treatment guidelines, and provide valuable insights for future clinical research, which remains insufficiently developed.

• #27 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #28 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #29 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #30 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #31

  https://consensus.app/questions/treatment-for-psychotic-depression/

  Psychotic depression, also known as major depressive disorder with psychotic features, is a severe mental health condition characterized by the presence of depressive symptoms along with psychosis, such as delusions or hallucinations. The treatment of psychotic depression is complex and often requires a combination of therapeutic approaches. […] The effectiveness of antidepressant monotherapy in treating psychotic depression is uncertain. Studies have shown no significant difference in depression response between antidepressant monotherapy and placebo. Additionally, recovery with tricyclic antidepressant monotherapy is less likely compared to combination treatments. […] Similarly, antipsychotic monotherapy has not shown significant efficacy in treating psychotic depression. Research indicates no substantial difference in depression response between antipsychotic monotherapy and placebo. Moreover, treatment with an antipsychotic alone is generally not recommended due to its limited effectiveness.

• #32

  https://consensus.app/questions/treatment-for-psychotic-depression/

  Psychotic depression, also known as major depressive disorder with psychotic features, is a severe mental health condition characterized by the presence of depressive symptoms along with psychosis, such as delusions or hallucinations. The treatment of psychotic depression is complex and often requires a combination of therapeutic approaches. […] The effectiveness of antidepressant monotherapy in treating psychotic depression is uncertain. Studies have shown no significant difference in depression response between antidepressant monotherapy and placebo. Additionally, recovery with tricyclic antidepressant monotherapy is less likely compared to combination treatments. […] Similarly, antipsychotic monotherapy has not shown significant efficacy in treating psychotic depression. Research indicates no substantial difference in depression response between antipsychotic monotherapy and placebo. Moreover, treatment with an antipsychotic alone is generally not recommended due to its limited effectiveness.

• #33

  https://consensus.app/questions/treatment-for-psychotic-depression/

  Combination therapy involving both an antidepressant and an antipsychotic has been found to be more effective than either treatment alone. Studies suggest that this combination is significantly more effective in reducing depressive symptoms compared to antidepressant or antipsychotic monotherapy. This approach is supported by multiple treatment guidelines and is often recommended as a first-line treatment for acute episodes of psychotic depression. […] Electroconvulsive therapy (ECT) is another effective treatment option for psychotic depression. ECT has been shown to be particularly effective and is often considered when rapid symptom relief is necessary or when pharmacological treatments are ineffective. Some studies suggest that ECT may be superior to combination drug therapy, especially bilateral ECT.

• #34 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  Determining the optimal continuation and maintenance therapy for psychotic depression is of special concern because of the high rate of relapse observed in naturalistic follow-up studies of psychotic depression, including relapse after ECT. […] During maintenance treatment of unipolar psychotic depression with combination pharmacotherapy, the antidepressant is generally maintained longer than the antipsychotic. […] For patients who relapse while discontinuing the antipsychotic during maintenance treatment of prior episodes of psychotic depression, it is reasonable to maintain the antipsychotic for at least six to 12 months. […] Given the serious morbidity and mortality of psychotic depression, I recommend lifetime treatment with the antidepressant.

• #35 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  Determining the optimal continuation and maintenance therapy for psychotic depression is of special concern because of the high rate of relapse observed in naturalistic follow-up studies of psychotic depression, including relapse after ECT. […] During maintenance treatment of unipolar psychotic depression with combination pharmacotherapy, the antidepressant is generally maintained longer than the antipsychotic. […] For patients who relapse while discontinuing the antipsychotic during maintenance treatment of prior episodes of psychotic depression, it is reasonable to maintain the antipsychotic for at least six to 12 months. […] Given the serious morbidity and mortality of psychotic depression, I recommend lifetime treatment with the antidepressant.

• #36 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  Determining the optimal continuation and maintenance therapy for psychotic depression is of special concern because of the high rate of relapse observed in naturalistic follow-up studies of psychotic depression, including relapse after ECT. […] During maintenance treatment of unipolar psychotic depression with combination pharmacotherapy, the antidepressant is generally maintained longer than the antipsychotic. […] For patients who relapse while discontinuing the antipsychotic during maintenance treatment of prior episodes of psychotic depression, it is reasonable to maintain the antipsychotic for at least six to 12 months. […] Given the serious morbidity and mortality of psychotic depression, I recommend lifetime treatment with the antidepressant.

• #37 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  Determining the optimal continuation and maintenance therapy for psychotic depression is of special concern because of the high rate of relapse observed in naturalistic follow-up studies of psychotic depression, including relapse after ECT. […] During maintenance treatment of unipolar psychotic depression with combination pharmacotherapy, the antidepressant is generally maintained longer than the antipsychotic. […] For patients who relapse while discontinuing the antipsychotic during maintenance treatment of prior episodes of psychotic depression, it is reasonable to maintain the antipsychotic for at least six to 12 months. […] Given the serious morbidity and mortality of psychotic depression, I recommend lifetime treatment with the antidepressant.

• #38 Combined drug therapy for at least 36 weeks reduces relapse after psychotic depression

  https://evidence.nihr.ac.uk/alert/combined-drug-therapy-for-at-least-36-weeks-reduces-relapse-after-psychotic-depression/

  Patients with psychotic depression who achieve remission benefit from continuing the antipsychotic drug olanzapine, alongside the antidepressant sertraline for at least a further four months, a North American trial has found. […] Patients who reduced and stopped olanzapine when their condition stabilised were more than twice as likely to relapse when compared with those who continued combined drug therapy. […] These results suggest that continuation of combined drug therapy for these patients may help reduce the risks of potentially life-threatening relapse. […] The STOP-PD II trial aimed to assess the risks and benefits of continuing antipsychotic medication in patients with psychotic depression after the patient has responded to treatment with sertraline plus olanzapine. […] This trial helps inform practice by showing that the continuation of antipsychotic medication after recovery had superior outcomes to its discontinuation once individuals were well, with fewer subsequent episodes of relapse.

• #39 Combined drug therapy for at least 36 weeks reduces relapse after psychotic depression

  https://evidence.nihr.ac.uk/alert/combined-drug-therapy-for-at-least-36-weeks-reduces-relapse-after-psychotic-depression/

  Patients with psychotic depression who achieve remission benefit from continuing the antipsychotic drug olanzapine, alongside the antidepressant sertraline for at least a further four months, a North American trial has found. […] Patients who reduced and stopped olanzapine when their condition stabilised were more than twice as likely to relapse when compared with those who continued combined drug therapy. […] These results suggest that continuation of combined drug therapy for these patients may help reduce the risks of potentially life-threatening relapse. […] The STOP-PD II trial aimed to assess the risks and benefits of continuing antipsychotic medication in patients with psychotic depression after the patient has responded to treatment with sertraline plus olanzapine. […] This trial helps inform practice by showing that the continuation of antipsychotic medication after recovery had superior outcomes to its discontinuation once individuals were well, with fewer subsequent episodes of relapse.

• #40 Combined drug therapy for at least 36 weeks reduces relapse after psychotic depression

  https://evidence.nihr.ac.uk/alert/combined-drug-therapy-for-at-least-36-weeks-reduces-relapse-after-psychotic-depression/

  Patients with psychotic depression who achieve remission benefit from continuing the antipsychotic drug olanzapine, alongside the antidepressant sertraline for at least a further four months, a North American trial has found. […] Patients who reduced and stopped olanzapine when their condition stabilised were more than twice as likely to relapse when compared with those who continued combined drug therapy. […] These results suggest that continuation of combined drug therapy for these patients may help reduce the risks of potentially life-threatening relapse. […] The STOP-PD II trial aimed to assess the risks and benefits of continuing antipsychotic medication in patients with psychotic depression after the patient has responded to treatment with sertraline plus olanzapine. […] This trial helps inform practice by showing that the continuation of antipsychotic medication after recovery had superior outcomes to its discontinuation once individuals were well, with fewer subsequent episodes of relapse.

• #41 Maintenance Treatment of Psychotic Depression: How Long to Continue the Antipsychotic?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na49754/2019/09/05/maintenance-treatment-psychotic-depression-how-long

  Relapse rate more than doubled when the antipsychotic was discontinued 20 weeks after initiating combined antidepressant–antipsychotic treatment. […] The most effective acute treatment for patients with psychotic depression is an antidepressant plus an antipsychotic, but after response, should treatment be continued? […] Relapse was more than twice as likely in the sertraline-placebo group than the sertraline-olanzapine group (55% vs. 20%). […] These results suggest that risk for relapse is much greater if the antipsychotic is discontinued after about 20 weeks of combined treatment (even though one in five patients relapsed with ongoing antipsychotic treatment). […] Although most relapses occurred within the first 2 months, it’s unknown how much longer than an additional 2 months the antipsychotic must be continued to attenuate this risk. […] An editorialist suggests that, in the absence of more-definitive data, clinicians should continue the antipsychotic for at least 4 months after response, then gradually taper it while observing for signs of relapse — and reinstituting the last effective dose if these signs occur.

• #42 Maintenance Treatment of Psychotic Depression: How Long to Continue the Antipsychotic?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na49754/2019/09/05/maintenance-treatment-psychotic-depression-how-long

  Relapse rate more than doubled when the antipsychotic was discontinued 20 weeks after initiating combined antidepressant–antipsychotic treatment. […] The most effective acute treatment for patients with psychotic depression is an antidepressant plus an antipsychotic, but after response, should treatment be continued? […] Relapse was more than twice as likely in the sertraline-placebo group than the sertraline-olanzapine group (55% vs. 20%). […] These results suggest that risk for relapse is much greater if the antipsychotic is discontinued after about 20 weeks of combined treatment (even though one in five patients relapsed with ongoing antipsychotic treatment). […] Although most relapses occurred within the first 2 months, it’s unknown how much longer than an additional 2 months the antipsychotic must be continued to attenuate this risk. […] An editorialist suggests that, in the absence of more-definitive data, clinicians should continue the antipsychotic for at least 4 months after response, then gradually taper it while observing for signs of relapse — and reinstituting the last effective dose if these signs occur.

• #43 Combined drug therapy for at least 36 weeks reduces relapse after psychotic depression

  https://evidence.nihr.ac.uk/alert/combined-drug-therapy-for-at-least-36-weeks-reduces-relapse-after-psychotic-depression/

  These results provide good evidence that combination therapy may be continued for at least six months after achieving remission where appropriate. […] Since this study ended at 36 weeks, it does not tell us the optimal duration of treatment with olanzapine following remission of psychotic depression but does usefully highlight the risks of withdrawing this medication too soon.

• #44 Combined drug therapy for at least 36 weeks reduces relapse after psychotic depression

  https://evidence.nihr.ac.uk/alert/combined-drug-therapy-for-at-least-36-weeks-reduces-relapse-after-psychotic-depression/

  These results provide good evidence that combination therapy may be continued for at least six months after achieving remission where appropriate. […] Since this study ended at 36 weeks, it does not tell us the optimal duration of treatment with olanzapine following remission of psychotic depression but does usefully highlight the risks of withdrawing this medication too soon.

• #45 Maintenance Treatment of Psychotic Depression: How Long to Continue the Antipsychotic?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na49754/2019/09/05/maintenance-treatment-psychotic-depression-how-long

  Relapse rate more than doubled when the antipsychotic was discontinued 20 weeks after initiating combined antidepressant–antipsychotic treatment. […] The most effective acute treatment for patients with psychotic depression is an antidepressant plus an antipsychotic, but after response, should treatment be continued? […] Relapse was more than twice as likely in the sertraline-placebo group than the sertraline-olanzapine group (55% vs. 20%). […] These results suggest that risk for relapse is much greater if the antipsychotic is discontinued after about 20 weeks of combined treatment (even though one in five patients relapsed with ongoing antipsychotic treatment). […] Although most relapses occurred within the first 2 months, it’s unknown how much longer than an additional 2 months the antipsychotic must be continued to attenuate this risk. […] An editorialist suggests that, in the absence of more-definitive data, clinicians should continue the antipsychotic for at least 4 months after response, then gradually taper it while observing for signs of relapse — and reinstituting the last effective dose if these signs occur.

• #46 Maintenance Treatment of Psychotic Depression: How Long to Continue the Antipsychotic?logo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na49754/2019/09/05/maintenance-treatment-psychotic-depression-how-long

  Relapse rate more than doubled when the antipsychotic was discontinued 20 weeks after initiating combined antidepressant–antipsychotic treatment. […] The most effective acute treatment for patients with psychotic depression is an antidepressant plus an antipsychotic, but after response, should treatment be continued? […] Relapse was more than twice as likely in the sertraline-placebo group than the sertraline-olanzapine group (55% vs. 20%). […] These results suggest that risk for relapse is much greater if the antipsychotic is discontinued after about 20 weeks of combined treatment (even though one in five patients relapsed with ongoing antipsychotic treatment). […] Although most relapses occurred within the first 2 months, it’s unknown how much longer than an additional 2 months the antipsychotic must be continued to attenuate this risk. […] An editorialist suggests that, in the absence of more-definitive data, clinicians should continue the antipsychotic for at least 4 months after response, then gradually taper it while observing for signs of relapse — and reinstituting the last effective dose if these signs occur.

• #47 Stanford researchers study controversial drug as treatment for psychotic major depression | News Center

  https://med.stanford.edu/news/all-news/2002/08/stanford-researchers-study-controversial-drug-as-treatment-for-psychotic-major-depression.html

  Sufferers of psychotic major depression, a severe and debilitating form of mental illness, improve slowly or not at all with standard medication. […] Researchers at Stanford University Medical Center have used the drug mifepristone, also known as RU-486, to treat these patients quickly and effectively. […] The treatment is potentially controversial because mifepristone is widely known as a drug that induces abortions. […] Researchers have learned, however, that certain properties of the drug that lead to pregnancy termination can also help treat psychotic major depression. […] Antidepressant medications alone are usually ineffective for these patients, and combining antidepressants with antipsychotic drugs improve symptoms for only about 60 percent of them. […] In the study, 30 patients received either a low, medium or high dose of mifepristone, each day for a week in addition to their standard medications.

• #48 Stanford researchers study controversial drug as treatment for psychotic major depression | News Center

  https://med.stanford.edu/news/all-news/2002/08/stanford-researchers-study-controversial-drug-as-treatment-for-psychotic-major-depression.html

  Sufferers of psychotic major depression, a severe and debilitating form of mental illness, improve slowly or not at all with standard medication. […] Researchers at Stanford University Medical Center have used the drug mifepristone, also known as RU-486, to treat these patients quickly and effectively. […] The treatment is potentially controversial because mifepristone is widely known as a drug that induces abortions. […] Researchers have learned, however, that certain properties of the drug that lead to pregnancy termination can also help treat psychotic major depression. […] Antidepressant medications alone are usually ineffective for these patients, and combining antidepressants with antipsychotic drugs improve symptoms for only about 60 percent of them. […] In the study, 30 patients received either a low, medium or high dose of mifepristone, each day for a week in addition to their standard medications.

• #49 Stanford researchers study controversial drug as treatment for psychotic major depression | News Center

  https://med.stanford.edu/news/all-news/2002/08/stanford-researchers-study-controversial-drug-as-treatment-for-psychotic-major-depression.html

  Sufferers of psychotic major depression, a severe and debilitating form of mental illness, improve slowly or not at all with standard medication. […] Researchers at Stanford University Medical Center have used the drug mifepristone, also known as RU-486, to treat these patients quickly and effectively. […] The treatment is potentially controversial because mifepristone is widely known as a drug that induces abortions. […] Researchers have learned, however, that certain properties of the drug that lead to pregnancy termination can also help treat psychotic major depression. […] Antidepressant medications alone are usually ineffective for these patients, and combining antidepressants with antipsychotic drugs improve symptoms for only about 60 percent of them. […] In the study, 30 patients received either a low, medium or high dose of mifepristone, each day for a week in addition to their standard medications.

• #50 Stanford researchers study controversial drug as treatment for psychotic major depression | News Center

  https://med.stanford.edu/news/all-news/2002/08/stanford-researchers-study-controversial-drug-as-treatment-for-psychotic-major-depression.html

  More than two-thirds of patients in the medium- and high-dose groups showed significant reductions in psychotic symptoms within seven days. […] The treatment may be the equivalent of shock treatments in a pill without the morbidity. […] Mifepristone blocks one of the cortisol receptors and also may reset the axis, since improvements persisted for patients in the study even after they stopped taking the drug. […] Mifepristone also has a low incidence of side effects compared to antidepressants and antipsychotics. […] A double-blind, placebo-controlled study of mifepristone is under way, funded by Corcept Therapeutics based in Menlo Park, Calif. […] Now the federal Food and Drug Administration has put mifepristone on fast-track approval as a treatment for psychotic depression; it is the first drug for a psychiatric condition to be fast-tracked. […] We’re using mifepristone as a lifesaver instead of an abortifacient.

• #51 Stanford researchers study controversial drug as treatment for psychotic major depression | News Center

  https://med.stanford.edu/news/all-news/2002/08/stanford-researchers-study-controversial-drug-as-treatment-for-psychotic-major-depression.html

  More than two-thirds of patients in the medium- and high-dose groups showed significant reductions in psychotic symptoms within seven days. […] The treatment may be the equivalent of shock treatments in a pill without the morbidity. […] Mifepristone blocks one of the cortisol receptors and also may reset the axis, since improvements persisted for patients in the study even after they stopped taking the drug. […] Mifepristone also has a low incidence of side effects compared to antidepressants and antipsychotics. […] A double-blind, placebo-controlled study of mifepristone is under way, funded by Corcept Therapeutics based in Menlo Park, Calif. […] Now the federal Food and Drug Administration has put mifepristone on fast-track approval as a treatment for psychotic depression; it is the first drug for a psychiatric condition to be fast-tracked. […] We’re using mifepristone as a lifesaver instead of an abortifacient.

• #52 Stanford researchers study controversial drug as treatment for psychotic major depression | News Center

  https://med.stanford.edu/news/all-news/2002/08/stanford-researchers-study-controversial-drug-as-treatment-for-psychotic-major-depression.html

  More than two-thirds of patients in the medium- and high-dose groups showed significant reductions in psychotic symptoms within seven days. […] The treatment may be the equivalent of shock treatments in a pill without the morbidity. […] Mifepristone blocks one of the cortisol receptors and also may reset the axis, since improvements persisted for patients in the study even after they stopped taking the drug. […] Mifepristone also has a low incidence of side effects compared to antidepressants and antipsychotics. […] A double-blind, placebo-controlled study of mifepristone is under way, funded by Corcept Therapeutics based in Menlo Park, Calif. […] Now the federal Food and Drug Administration has put mifepristone on fast-track approval as a treatment for psychotic depression; it is the first drug for a psychiatric condition to be fast-tracked. […] We’re using mifepristone as a lifesaver instead of an abortifacient.

• #53 Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression

  https://www.mdpi.com/2076-3425/13/1/142

  Psychotic treatment-resistant depression is a complex and challenging manifestation of mood disorders in the clinical setting. Psychotic depression is a subtype of major depressive disorder characterized by mood-consistent hallucinations and/or delusions. Psychotic depression is often underdiagnosed and undertreated. Ketamine appears to have rapid and potent antidepressant effects in clinical studies, and the Federal Drug Agency approved the use of ketamine enantiomer esketamine-nasal spray for treatment-resistant depression pharmacotherapy in 2019. This study aimed to assess the usage of ketamine for major depressive disorder with psychotic features as an add-on treatment to the standard of care. […] As known treatments for MDD with psychotic features are approved, therapies are based upon clinical treatment guidelines supported by registry data and prioritize combined treatments with antidepressants (ADT) and antipsychotics or electroconvulsive therapy ECT. However, a proportion of patients with MDD with psychotic features present psychotic treatment-resistant depression (TRD) and do not respond to recommended therapeutic interventions.

• #54 Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression

  https://www.mdpi.com/2076-3425/13/1/142

  The observation that the dissociative anesthetic drug ketamine produces a rapid antidepressant effect in treatment-resistant patients with MDD, along with extensive research with ketamine racemic mixture as well as it is (R)-ketamine (arketamine) and (S)-ketamine (esketamine) enantiomers led to the clinical development and regulatory approval for esketamine-nasal spray (ESK-NS) as an add-on treatment to oral ADT in TRD in acute management and relapse prevention. […] Ketamine and its enantiomers exhibit a favorable safety and tolerability profile. The commonly reported adverse drug reactions include psychotomimetic phenomena that are dose-related and self-limiting in time with no sequelae and symptomatology abatement at the time of treatment. […] This report supports evidence for good ketamine safety and tolerance in TRD with psychotic symptoms, including one case with suicidality. In line with limited previous reports, no psychotic exacerbation was observed in short and long-term observation.

• #55 Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression

  https://www.mdpi.com/2076-3425/13/1/142

  The observation that the dissociative anesthetic drug ketamine produces a rapid antidepressant effect in treatment-resistant patients with MDD, along with extensive research with ketamine racemic mixture as well as it is (R)-ketamine (arketamine) and (S)-ketamine (esketamine) enantiomers led to the clinical development and regulatory approval for esketamine-nasal spray (ESK-NS) as an add-on treatment to oral ADT in TRD in acute management and relapse prevention. […] Ketamine and its enantiomers exhibit a favorable safety and tolerability profile. The commonly reported adverse drug reactions include psychotomimetic phenomena that are dose-related and self-limiting in time with no sequelae and symptomatology abatement at the time of treatment. […] This report supports evidence for good ketamine safety and tolerance in TRD with psychotic symptoms, including one case with suicidality. In line with limited previous reports, no psychotic exacerbation was observed in short and long-term observation.

• #56 Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression

  https://www.mdpi.com/2076-3425/13/1/142

  The observation that the dissociative anesthetic drug ketamine produces a rapid antidepressant effect in treatment-resistant patients with MDD, along with extensive research with ketamine racemic mixture as well as it is (R)-ketamine (arketamine) and (S)-ketamine (esketamine) enantiomers led to the clinical development and regulatory approval for esketamine-nasal spray (ESK-NS) as an add-on treatment to oral ADT in TRD in acute management and relapse prevention. […] Ketamine and its enantiomers exhibit a favorable safety and tolerability profile. The commonly reported adverse drug reactions include psychotomimetic phenomena that are dose-related and self-limiting in time with no sequelae and symptomatology abatement at the time of treatment. […] This report supports evidence for good ketamine safety and tolerance in TRD with psychotic symptoms, including one case with suicidality. In line with limited previous reports, no psychotic exacerbation was observed in short and long-term observation.

• #57 Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression

  https://www.mdpi.com/2076-3425/13/1/142

  Our results support the notion that a history of psychosis should not exclude people from receiving ketamine in a therapeutic context. However, such patients may be at risk of experiencing more significant short-term dissociative symptoms. […] This paper contributes to the literature supporting the rapid antidepressant effect in TRD and demonstrates the good safety and tolerability profile of intravenous ketamine use as the add-on SOC in psychotic TRD.

• #58

  https://link.springer.com/article/10.1007/s40501-024-00329-6

  Major depressive disorder (MDD) with psychotic features is a medical condition where patients suffer from depressed mood and psychotic symptoms, such as delusions. […] The purpose of this comprehensive review is to explore recent and breakthrough treatment targets in psychotic depression, by collecting, analyzing and processing scientific articles on the online databases of PubMed, GoogleScholar and ResearchGate. […] The evidence suggests a role in targeting certain pathways and receptors in the brain that are linked with mood disorders and can be associated with the pathogenesis of psychotic depression. […] The hypothalamic-pituitary-adrenal (HPA) axis dysfunction and glucocorticoid receptors, and glutamate and NMDA receptors have been associated with psychotic depression and its targeting has shown to have improved the severity of the psychotic symptoms.

• #59

  https://link.springer.com/article/10.1007/s40501-024-00329-6

  Major depressive disorder (MDD) with psychotic features is a medical condition where patients suffer from depressed mood and psychotic symptoms, such as delusions. […] The purpose of this comprehensive review is to explore recent and breakthrough treatment targets in psychotic depression, by collecting, analyzing and processing scientific articles on the online databases of PubMed, GoogleScholar and ResearchGate. […] The evidence suggests a role in targeting certain pathways and receptors in the brain that are linked with mood disorders and can be associated with the pathogenesis of psychotic depression. […] The hypothalamic-pituitary-adrenal (HPA) axis dysfunction and glucocorticoid receptors, and glutamate and NMDA receptors have been associated with psychotic depression and its targeting has shown to have improved the severity of the psychotic symptoms.

• #60

  https://link.springer.com/article/10.1007/s40501-024-00329-6

  Also, novel antipsychotics are partial agonists of the Dopamine D2 and D3 receptors which have been implicated in the improvement of not only psychotic symptoms but also depressive ones. […] Limited data is currently available on newer, breakthrough treatment targets in psychotic depression. […] There are promising treatment targets such as the targeting of glucocorticoid receptors, glutamate receptors and specific dopamine receptors that need further research and trials in order to be considered as important strategic resources for the treatment of psychotic depression.

• #61

  https://link.springer.com/article/10.1007/s40501-024-00329-6

  Also, novel antipsychotics are partial agonists of the Dopamine D2 and D3 receptors which have been implicated in the improvement of not only psychotic symptoms but also depressive ones. […] Limited data is currently available on newer, breakthrough treatment targets in psychotic depression. […] There are promising treatment targets such as the targeting of glucocorticoid receptors, glutamate receptors and specific dopamine receptors that need further research and trials in order to be considered as important strategic resources for the treatment of psychotic depression.

• #62

  https://link.springer.com/article/10.1007/s40501-024-00329-6

  Also, novel antipsychotics are partial agonists of the Dopamine D2 and D3 receptors which have been implicated in the improvement of not only psychotic symptoms but also depressive ones. […] Limited data is currently available on newer, breakthrough treatment targets in psychotic depression. […] There are promising treatment targets such as the targeting of glucocorticoid receptors, glutamate receptors and specific dopamine receptors that need further research and trials in order to be considered as important strategic resources for the treatment of psychotic depression.

• #63 Depression (major depressive disorder) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

  Medications and psychotherapy are effective for most people with depression. […] If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve. […] Many types of antidepressants are available, including those below. […] Doctors often start by prescribing an SSRI. […] These drugs are considered safer and generally cause fewer bothersome side effects than other types of antidepressants. […] Other medications may be added to an antidepressant to enhance antidepressant effects. […] Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health professional. […] Different types of psychotherapy can be effective for depression, such as cognitive behavioral therapy or interpersonal therapy.

• #64 Major depression with psychotic features – UF Health

  https://ufhealth.org/conditions-and-treatments/major-depression-with-psychotic-features

  Major depression with psychotic features is a mental disorder in which a person has depression along with loss of touch with reality (psychosis). […] Psychotic depression requires immediate medical care and treatment. […] Treatment usually involves antidepressant and antipsychotic medicine. You may only need antipsychotic medicine for a short period of time. […] Electroconvulsive therapy can help treat depression with psychotic symptoms. However, medicine is usually tried first. […] This is a serious condition. You will need immediate treatment and close monitoring by a provider. […] You may need to take medicine for a long time to prevent the depression from coming back. Depression symptoms are more likely to return than psychotic symptoms. […] The risk for suicide is much higher in people with depression with psychotic symptoms than in those without psychosis.

• #65 Understanding and Treating Psychotic Depression

  https://reallifecounseling.us/blog/psychotic-depression

  Psychotic depression sometimes referred to as delusional depression, is characterized as a major depressive disorder in which an individual experiences a combination of depressed thoughts and loss of reality (psychosis), presenting itself in the forms of hallucinations and/or delusions. […] Appropriate treatment is a critical step in preventing someone from hurting themselves or others. Medication, counseling, and observation, amongst other treatments, can help individuals who are affected live a normal life. […] The first step to diagnosing and treating psychotic depression is under close watch at a mental facility. This step is needed in order for mental health professionals to observe psychotic symptoms and pinpoint what antipsychotic medications need to be given in order to help the patient through the psychosis.

• #66 Understanding and Treating Psychotic Depression

  https://reallifecounseling.us/blog/psychotic-depression

  After the patient is more in touch with reality, treatment of the depression symptoms can then be targeted and treated through the use of antidepressant medication. […] Ongoing therapy is also a critical and helpful part of dealing with psychotic depression. Qualified therapists can help people cope with struggles, find strength from within, reach their goals, and allow them to feel heard and valued.

• #67 Psychotic Disorders: Types, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/schizophrenia/mental-health-psychotic-disorders

  It’s important that you work with your doctor to find the right combination of medicines for you. And be patient because it can take several weeks or months for you to see improvement. […] Treatment will usually take a multi-faceted approach including an antipsychotic medicine, other medicines necessary to manage your symptoms, cognitive or behavioral therapy, and other support services you need to meet your treatment goals.

• #68 Psychotic Disorders: Types, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/schizophrenia/mental-health-psychotic-disorders

  It’s important that you work with your doctor to find the right combination of medicines for you. And be patient because it can take several weeks or months for you to see improvement. […] Treatment will usually take a multi-faceted approach including an antipsychotic medicine, other medicines necessary to manage your symptoms, cognitive or behavioral therapy, and other support services you need to meet your treatment goals.

• #69 Treatment – Psychosis – NHS

  https://www.nhs.uk/mental-health/conditions/psychosis/treatment/

  Antipsychotic medicines are usually recommended as the first treatment for psychosis. […] Antipsychotics can usually reduce feelings of anxiety within a few hours of use, but they may take several days or weeks to reduce psychotic symptoms, such as hallucinations or delusional thoughts. […] Antipsychotics can have side effects, although not everyone will experience them and their severity will differ from person to person. […] Tell a GP or mental health worker if you have side effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take that causes less side effects. […] Rarely, antipsychotics can trigger suicidal feelings or an urge to self-harm. […] Never stop taking medicine prescribed for you unless advised to do so by a qualified healthcare professional responsible for your care. […] Family therapy involves a series of meetings that take place over a period of 3 months or more. Meetings may include discussing your condition and how it might progress, plus the available treatments.

• #70 Treatment – Psychosis – NHS

  https://www.nhs.uk/mental-health/conditions/psychosis/treatment/

  Antipsychotic medicines are usually recommended as the first treatment for psychosis. […] Antipsychotics can usually reduce feelings of anxiety within a few hours of use, but they may take several days or weeks to reduce psychotic symptoms, such as hallucinations or delusional thoughts. […] Antipsychotics can have side effects, although not everyone will experience them and their severity will differ from person to person. […] Tell a GP or mental health worker if you have side effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take that causes less side effects. […] Rarely, antipsychotics can trigger suicidal feelings or an urge to self-harm. […] Never stop taking medicine prescribed for you unless advised to do so by a qualified healthcare professional responsible for your care. […] Family therapy involves a series of meetings that take place over a period of 3 months or more. Meetings may include discussing your condition and how it might progress, plus the available treatments.

• #71 Treatment – Psychosis – NHS

  https://www.nhs.uk/mental-health/conditions/psychosis/treatment/

  Antipsychotic medicines are usually recommended as the first treatment for psychosis. […] Antipsychotics can usually reduce feelings of anxiety within a few hours of use, but they may take several days or weeks to reduce psychotic symptoms, such as hallucinations or delusional thoughts. […] Antipsychotics can have side effects, although not everyone will experience them and their severity will differ from person to person. […] Tell a GP or mental health worker if you have side effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take that causes less side effects. […] Rarely, antipsychotics can trigger suicidal feelings or an urge to self-harm. […] Never stop taking medicine prescribed for you unless advised to do so by a qualified healthcare professional responsible for your care. […] Family therapy involves a series of meetings that take place over a period of 3 months or more. Meetings may include discussing your condition and how it might progress, plus the available treatments.

• #72 Treatment – Psychosis – NHS

  https://www.nhs.uk/mental-health/conditions/psychosis/treatment/

  Antipsychotic medicines are usually recommended as the first treatment for psychosis. […] Antipsychotics can usually reduce feelings of anxiety within a few hours of use, but they may take several days or weeks to reduce psychotic symptoms, such as hallucinations or delusional thoughts. […] Antipsychotics can have side effects, although not everyone will experience them and their severity will differ from person to person. […] Tell a GP or mental health worker if you have side effects that are becoming particularly troublesome. There may be an alternative antipsychotic medicine you can take that causes less side effects. […] Rarely, antipsychotics can trigger suicidal feelings or an urge to self-harm. […] Never stop taking medicine prescribed for you unless advised to do so by a qualified healthcare professional responsible for your care. […] Family therapy involves a series of meetings that take place over a period of 3 months or more. Meetings may include discussing your condition and how it might progress, plus the available treatments.

• #73 Psychotic depression – HSE.ie

  https://www2.hse.ie/conditions/clinical-depression/psychotic-depression/

  If you have psychotic depression, you may also have psychomotor retardation. This is when your thoughts and physical movements slow down. […] Treatment for psychotic depression involves: […] medicine – antipsychotics and antidepressants […] psychological therapies – cognitive behavioural therapy (CBT) […] social support – support with social needs, such as education, employment or accommodation. […] You may need to stay in hospital for a short time while you are getting treatment. […] Electroconvulsive therapy (ECT) is sometimes used if all other treatments have not worked.

• #74 Psychotic depression – HSE.ie

  https://www2.hse.ie/conditions/clinical-depression/psychotic-depression/

  If you have psychotic depression, you may also have psychomotor retardation. This is when your thoughts and physical movements slow down. […] Treatment for psychotic depression involves: […] medicine – antipsychotics and antidepressants […] psychological therapies – cognitive behavioural therapy (CBT) […] social support – support with social needs, such as education, employment or accommodation. […] You may need to stay in hospital for a short time while you are getting treatment. […] Electroconvulsive therapy (ECT) is sometimes used if all other treatments have not worked.

• #75 Psychotic depression – HSE.ie

  https://www2.hse.ie/conditions/clinical-depression/psychotic-depression/

  If you have psychotic depression, you may also have psychomotor retardation. This is when your thoughts and physical movements slow down. […] Treatment for psychotic depression involves: […] medicine – antipsychotics and antidepressants […] psychological therapies – cognitive behavioural therapy (CBT) […] social support – support with social needs, such as education, employment or accommodation. […] You may need to stay in hospital for a short time while you are getting treatment. […] Electroconvulsive therapy (ECT) is sometimes used if all other treatments have not worked.

• #76 Psychotic depression – HSE.ie

  https://www2.hse.ie/conditions/clinical-depression/psychotic-depression/

  If you have psychotic depression, you may also have psychomotor retardation. This is when your thoughts and physical movements slow down. […] Treatment for psychotic depression involves: […] medicine – antipsychotics and antidepressants […] psychological therapies – cognitive behavioural therapy (CBT) […] social support – support with social needs, such as education, employment or accommodation. […] You may need to stay in hospital for a short time while you are getting treatment. […] Electroconvulsive therapy (ECT) is sometimes used if all other treatments have not worked.

• #77 Psychotic depression – HSE.ie

  https://www2.hse.ie/conditions/clinical-depression/psychotic-depression/

  If you have psychotic depression, you may also have psychomotor retardation. This is when your thoughts and physical movements slow down. […] Treatment for psychotic depression involves: […] medicine – antipsychotics and antidepressants […] psychological therapies – cognitive behavioural therapy (CBT) […] social support – support with social needs, such as education, employment or accommodation. […] You may need to stay in hospital for a short time while you are getting treatment. […] Electroconvulsive therapy (ECT) is sometimes used if all other treatments have not worked.

• #78 Understanding and Treating Psychotic Depression

  https://reallifecounseling.us/blog/psychotic-depression

  After the patient is more in touch with reality, treatment of the depression symptoms can then be targeted and treated through the use of antidepressant medication. […] Ongoing therapy is also a critical and helpful part of dealing with psychotic depression. Qualified therapists can help people cope with struggles, find strength from within, reach their goals, and allow them to feel heard and valued.

• #79 Treatment for Major Depression With Psychotic Features (Psychotic Depression)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6519655/

  The largest study of the combination of an antidepressant and an antipsychotic for the treatment of psychotic depression to date, the NIMH STOP-PD, reported that the combination of sertraline and olanzapine was more efficacious than monotherapy with olanzapine alone. […] In two randomized, placebo-controlled trials, a combination of fluoxetine plus olanzapine was compared with olanzapine monotherapy or placebo in 229 hospitalized patients with psychotic depression. […] The authors concluded that the combination of venlafaxine and quetiapine was more effective than venlafaxine alone on the primary outcome measure (response) and was well tolerated. […] Studies using older medications have reported efficacy with the combination of amitriptyline and perphenazine or amoxapine. […] Observational studies show that about 50% of patients with unipolar psychotic depression recover within two to three months, and the large majority of patients recover within six to 12 months.

• #80 Psychotic depression – NHS

  https://www.nhs.uk/mental-health/conditions/psychotic-depression/

  Treatment for psychotic depression involves: […] a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis […] the 1-to-1 talking therapy cognitive behavioural therapy (CBT) has proved effective in helping some people with severe depression, including those with psychosis […] support with social needs, such as education, employment or accommodation. […] Electroconvulsive therapy (ECT) may sometimes be recommended if the person has severe depression and other treatments, including antidepressants, have not worked. […] Treatment is usually effective, but follow-up appointments so that the person can be closely monitored are usually required.

• #81 Depression with psychosis: Symptoms, treatment, and recoveryMedical News Today

  https://www.medicalnewstoday.com/articles/323193

  Currently, no treatments can entirely cure psychotic depression. This means that people will usually need ongoing treatment. […] If people follow a treatment program, the long-term outlook for depression with psychosis is good. Medication or ECT can help manage even the most severe symptoms of psychotic depression.

• #82 Depression with psychosis: Symptoms, treatment, and recoveryMedical News Today

  https://www.medicalnewstoday.com/articles/323193

  Currently, no treatments can entirely cure psychotic depression. This means that people will usually need ongoing treatment. […] If people follow a treatment program, the long-term outlook for depression with psychosis is good. Medication or ECT can help manage even the most severe symptoms of psychotic depression.

• #83 Major depression with psychotic features – UF Health

  https://ufhealth.org/conditions-and-treatments/major-depression-with-psychotic-features

  Major depression with psychotic features is a mental disorder in which a person has depression along with loss of touch with reality (psychosis). […] Psychotic depression requires immediate medical care and treatment. […] Treatment usually involves antidepressant and antipsychotic medicine. You may only need antipsychotic medicine for a short period of time. […] Electroconvulsive therapy can help treat depression with psychotic symptoms. However, medicine is usually tried first. […] This is a serious condition. You will need immediate treatment and close monitoring by a provider. […] You may need to take medicine for a long time to prevent the depression from coming back. Depression symptoms are more likely to return than psychotic symptoms. […] The risk for suicide is much higher in people with depression with psychotic symptoms than in those without psychosis.

• #84 Major depression with psychotic features – UF Health

  https://ufhealth.org/conditions-and-treatments/major-depression-with-psychotic-features

  Major depression with psychotic features is a mental disorder in which a person has depression along with loss of touch with reality (psychosis). […] Psychotic depression requires immediate medical care and treatment. […] Treatment usually involves antidepressant and antipsychotic medicine. You may only need antipsychotic medicine for a short period of time. […] Electroconvulsive therapy can help treat depression with psychotic symptoms. However, medicine is usually tried first. […] This is a serious condition. You will need immediate treatment and close monitoring by a provider. […] You may need to take medicine for a long time to prevent the depression from coming back. Depression symptoms are more likely to return than psychotic symptoms. […] The risk for suicide is much higher in people with depression with psychotic symptoms than in those without psychosis.

• #85 Psychotic Depression – Bridges to Recovery

  https://www.bridgestorecovery.com/psychotic-depression/

  Despite the frightening nature of this disorder, the long-term prognosis for psychotic depression is highly promising for patients who remain committed to their depression recovery programs. Psychotic depression is responsive to comprehensive treatment, and in the long run its most severe symptoms can be effectively managed or eliminated.

• #86 Psychotic Depression | Behavioral and Mental Health | Mercy Health

  https://www.mercy.com/health-care-services/behavioral-mental-health/conditions/psychotic-depression

  There’s currently no cure for psychotic depression. There are treatments that can help relieve your symptoms. Your mental health professional can work with you and your loved ones to create a treatment plan. This may help you feel better and connect better with the world around you. […] Nonsurgical treatments for psychotic depression include the following: […] Medications are often a big part of treatment for psychotic depression. You might combine antidepressants and antipsychotic medicines so they work better. It can take some adjustment to find the right level of medicine for you. […] Some people respond well to therapy that uses an electric shock to help restore balance to the chemicals in their brains. You’re usually put to sleep under general anesthesia during this procedure. […] You might need to stay in the hospital for a while. This is especially true if you’re showing signs of suicidal thoughts. Doctors need to monitor your condition for your own safety. […] Early diagnosis is important for successful treatment of psychotic depression. It may be a scary diagnosis, but you can easily get help. Be sure that loved ones are aware of the situation and your treatment program so they can support you during this time.

• #87 Psychotic Depression: Symptoms, Causes, Diagnosis, and Treatment

  https://www.verywellmind.com/psychotic-depression-1066607

  Prognosis can depend on how soon someone receives treatment for psychotic depression. The longer it takes for treatment, the more likely it is that an individual may need emergency medical services. […] Researchers suggest that psychotic depression is understudied, underdiagnosed, and undertreated. Combination medication treatments and ECT have been shown to be effective, but further research is needed to establish how long antipsychotic medications need to be taken. […] The best way to cope is to talk to your doctor if you have symptoms of depression or suspect that you may be experiencing symptoms of psychosis. Once you have been treated and your condition has stabilized, be sure to stick to your doctor’s advice and continue taking your medication in order to prevent future relapse. […] Psychotic depression can be frightening, but effective treatments are available. Fortunately, the prognosis for recovery is good with appropriate treatment. With treatment, you can find relief from symptoms of depression and psychosis and feel more like your regular self.

• #88 Psychotic Depression: Symptoms, Causes, Diagnosis, and Treatment

  https://www.verywellmind.com/psychotic-depression-1066607

  Prognosis can depend on how soon someone receives treatment for psychotic depression. The longer it takes for treatment, the more likely it is that an individual may need emergency medical services. […] Researchers suggest that psychotic depression is understudied, underdiagnosed, and undertreated. Combination medication treatments and ECT have been shown to be effective, but further research is needed to establish how long antipsychotic medications need to be taken. […] The best way to cope is to talk to your doctor if you have symptoms of depression or suspect that you may be experiencing symptoms of psychosis. Once you have been treated and your condition has stabilized, be sure to stick to your doctor’s advice and continue taking your medication in order to prevent future relapse. […] Psychotic depression can be frightening, but effective treatments are available. Fortunately, the prognosis for recovery is good with appropriate treatment. With treatment, you can find relief from symptoms of depression and psychosis and feel more like your regular self.

• #89 Psychotic Depression: Symptoms, Causes, Diagnosis, and Treatment

  https://www.verywellmind.com/psychotic-depression-1066607

  Prognosis can depend on how soon someone receives treatment for psychotic depression. The longer it takes for treatment, the more likely it is that an individual may need emergency medical services. […] Researchers suggest that psychotic depression is understudied, underdiagnosed, and undertreated. Combination medication treatments and ECT have been shown to be effective, but further research is needed to establish how long antipsychotic medications need to be taken. […] The best way to cope is to talk to your doctor if you have symptoms of depression or suspect that you may be experiencing symptoms of psychosis. Once you have been treated and your condition has stabilized, be sure to stick to your doctor’s advice and continue taking your medication in order to prevent future relapse. […] Psychotic depression can be frightening, but effective treatments are available. Fortunately, the prognosis for recovery is good with appropriate treatment. With treatment, you can find relief from symptoms of depression and psychosis and feel more like your regular self.

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