title: A case study evaluating the use of clozapine in depression with psychotic features.
abstract: The purpose of this case study was to use an evidence based medicine approach to work through an unusual way of treating a common problem. We looked at an example of an in-patient with severe refractory psychotic depression who had been resistant to treatment with a combination of antidepressant, antipsychotics, mood stabiliser, and concomitant ECT therapy. We then undertook a literature search for the use of clozapine in a patient with severe refractory depression. Although the resulting evidence was low level and thin, we felt on balance that a trial of clozapine was justified. We used a BPRS inventory to monitor her mood prior to commencing clozapine. Her mood and functional abilities were monitored as her clozapine was titrated upwards. Our patient showed a significant improvement in mood and functional abilities and a reduction in her BPRS score during this period. Her symptoms improved to the point where she was successfully discharged home on a combination of clozapine and an antidepressant. The improvement was sustained for a further two years. We thought this was an important case to highlight the limited evidence in using this successful form of treatment for a common clinical problem and that further research in this area was needed.
authors.affiliation: Wimborne and Purbeck community mental health team, Oakley bungalow 15 Oakley Lane, Canford Magna, Wimborne, Dorset, BH21 1SF, UK. prem.jeyapaul@gmail.com
authors.forename: Premkumar
authors.initials: P
authors.lastname: Jeyapaul
authors.forename: Ray
authors.initials: R
authors.lastname: Vieweg