title: Pharmacological treatment for unipolar psychotic depression: Systematic review and meta-analysis.
abstract: BACKGROUND
  The optimal pharmacological treatment of unipolar psychotic depression is uncertain.
  
  
  OBJECTIVE
  To compare the clinical effectiveness of pharmacological treatments for patients with unipolar psychotic depression.
  
  
  METHODS
  Systematic review and meta-analysis of randomised controlled trials.
  
  
  RESULTS
  Ten trials were included in the review. We found no evidence that the combination of an antidepressant with an antipsychotic is more effective than an antidepressant alone. This combination was statistically more effective than an antipsychotic alone.
  
  
  CONCLUSIONS
  Antidepressant monotherapy and adding an antipsychotic if the patient does not respond, or starting with the combination of an antidepressant and an antipsychotic, both appear to be appropriate options for patients with unipolar psychotic depression. However, clinically the balance between risks and benefits may suggest the first option should be preferred for many patients. Starting with an antipsychotic alone appears to be inadequate.
authors.affiliation: Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre Utrecht, HP B01.206, PO Box 85500, 3508 GA, Utrecht, The Netherlands. j.wijkstra@azu.nl
authors.forename: Jaap
authors.initials: J
authors.lastname: Wijkstra
authors.forename: Jeroen
authors.initials: J
authors.lastname: Lijmer
authors.forename: Ferdi J
authors.initials: FJ
authors.lastname: Balk
authors.forename: John R
authors.initials: JR
authors.lastname: Geddes
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000341:Affective Disorders, Psychotic / Q000188:drug therapy*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents