title: Treatment of unipolar psychotic depression: a randomized, double-blind study comparing imipramine, venlafaxine, and venlafaxine plus quetiapine.
abstract: OBJECTIVE
  It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone.
  
  
  METHODS
  In a multi-center RCT, 122 patients (18-65 years) with DSM-IV-TR psychotic major depression and HAM-D-17 > or = 18 were randomized to 7 weeks imipramine (plasma-levels 200-300 microg/l), venlafaxine (375 mg/day) or venlafaxine-quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM-D-17. Secondary outcomes were response on CGI and remission (HAM-D-17).
  
  
  RESULTS
  Venlafaxine-quetiapine was more effective than venlafaxine with no significant differences between venlafaxine-quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern.
  
  
  CONCLUSIONS
  That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine-quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.
authors.affiliation: Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands. j.wijkstra@umcutrecht.nl
authors.forename: J
authors.initials: J
authors.lastname: Wijkstra
authors.forename: H
authors.initials: H
authors.lastname: Burger
authors.forename: W W
authors.initials: WW
authors.lastname: van den Broek
authors.forename: T K
authors.initials: TK
authors.lastname: Birkenhäger
authors.forename: J G E
authors.initials: JG
authors.lastname: Janzing
authors.forename: M P M
authors.initials: MP
authors.lastname: Boks
authors.forename: J A
authors.initials: JA
authors.lastname: Bruijn
authors.forename: M L M
authors.initials: ML
authors.lastname: van der Loos
authors.forename: L M T
authors.initials: LM
authors.lastname: Breteler
authors.forename: G M G I
authors.initials: GM
authors.lastname: Ramaekers
authors.forename: R J
authors.initials: RJ
authors.lastname: Verkes
authors.forename: W A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000293:Adolescent; D000328:Adult; D000341:Affective Disorders, Psychotic / Q000188:drug therapy*; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003511:Cyclohexanols / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D003987:Dibenzothiazepines / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000069348:Quetiapine Fumarate; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
chemical_list: D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D003511:Cyclohexanols; D003987:Dibenzothiazepines; D007099:Imipramine; D000069348:Quetiapine Fumarate; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride