title: Psychotic depression--beyond the antidepressant/antipsychotic combination.
abstract: Psychotic depression is an identified subtype of major depression that has many features of a distinct psychiatric disorder. Recent studies support previous findings that psychotic depression is associated with a less favorable course of illness. Moreover, the presence of a single psychotic symptom appears to predict decreased responsiveness to antidepressant monotherapy. Recent studies also support biological differences between psychotic and non-psychotic depression. Previous findings of greater HPA axis dysregulation are supported by evidence of diminished cortisol suppression with the mineralocorticoid antagonist fludrocortisone in psychotic depression. Moreover, a functional neuroimaging study demonstrated greater activation in parahippocampal and tempoparietal regions in psychotic depression during a memory task. In support of several previous treatment studies, a recent meta-analysis of studies that compared an antidepressant-antipsychotic combination to antidepressants or antipsychotics alone found a therapeutic advantage with the combined treatment over monotherapy. A recent clinical trial suggests that mifepristone, a glucocorticoid antagonist, may be an effective adjunctive treatment for psychotic depression.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Cincinnati VAMC, University of Cincinnati Academic Health Center, 260 Stetson Street, Suite 3200, Cincinnati, OH 45267-0559, USA. erik.nelson@uc.edu
authors.forename: Erik B
authors.initials: EB
authors.lastname: Nelson
mesh_terms: D000341:Affective Disorders, Psychotic / Q000188:drug therapy* / Q000503:physiopathology; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005438:Fludrocortisone / Q000627:therapeutic use; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D000451:Mineralocorticoid Receptor Antagonists; D005438:Fludrocortisone