Low use of neuroleptic drugs in the treatment of psychotic major depression.
OBJECTIVE
The adequacy of pharmacologic treatment received by patients with psychotic major depression was evaluated.


METHODS
The authors systematically assessed the pharmacotherapy received by 187 depressed patients before initiation of ECT and compared the medication trials of those with psychotic (N = 53) and nonpsychotic (N = 134) depression.


RESULTS
Despite a median of four medication trials and median index episode duration of 20 weeks, only two (4%) of the patients with psychotic depression received at least one adequate pharmacotherapy trial. In contrast, 70 (52%) of the patients with nonpsychotic depression received at least one adequate trial. Twenty-five (47%) of the patients with psychotic depression received either no neuroleptic treatment (N = 11) or treatment for less than 3 weeks (N = 14). Only eight (15%) received a daily neuroleptic dose higher than 200 mg of chlorpromazine equivalents.


CONCLUSIONS
These findings suggest that many patients with psychotic major depression referred for ECT receive inadequate pharmacotherapy because of either the absence or the inadequate use of neuroleptic medication.
Mulsant
B H
BH
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, PA, USA.
Haskett
R F
RF
Prudic
J
J
Thase
M E
ME
Malone
K M
KM
Mann
J J
JJ
Pettinati
H M
HM
Sackeim
H A
HA
D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology / Q000628:therapy; D004363:Drug Utilization; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation
D000928:Antidepressive Agents; D014150:Antipsychotic Agents