title: The treatment of psychotic depression: is there consensus among guidelines and psychiatrists?
abstract: BACKGROUND
  Psychotic depression (PD) is a prevalent, severe, under-diagnosed and often inadequately treated mental disorder, which has received disproportionally little attention by clinicians, researchers and the pharmaceutical industry. Consequently, the evidence base for optimal clinical practice regarding PD is limited. The aim of this study was to investigate the degree of consensus among international treatment guidelines on PD and to determine whether a potential lack of consensus would be reflected in the clinical practice of Danish psychiatrists.
  
  
  METHODS
  1. Review and comparison of international guidelines on the treatment of PD. 2. Questionnaire based survey regarding Danish psychiatrists' treatment of PD.
  
  
  RESULTS
  The nine international treatment guidelines considered in the review have contrasting opinions on the optimal treatment for PD: 6 of 9 suggest antidepressant (AD)+antipsychotic (AP) combination therapy, 3 of 9 recommend AD monotherapy and 5 of 9 find electroconvulsive therapy (ECT) equally appropriate as first line treatment. The 113 surveyed psychiatrists displayed the same lack of consensus. Their preferred treatment was either AD+AP combination therapy (42%), AD monotherapy (31%) or ECT (21%). The first line choices of ADs and APs were tricyclic antidepressants (51%) and quetiapine (62%), respectively.
  
  
  CONCLUSIONS
  The survey data are subjected to a potential selection bias as the respondents are likely to represent the more informed fraction of psychiatrists.
  
  
  CONCLUSIONS
  Our results indicate that both treatment algorithms and clinical practice regarding PD are highly heterogeneous. This finding emphasizes the need for further studies on the treatment of psychotic depression.
authors.affiliation: Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mølleparkvej 10, DK-9000 Aalborg, Denmark. a.k.leadholm@gmail.com
authors.forename: Anne Katrine K
authors.initials: AK
authors.lastname: Leadholm
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Rothschild
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
authors.forename: Per
authors.initials: P
authors.lastname: Bech
authors.forename: Povl
authors.initials: P
authors.lastname: Munk-Jørgensen
authors.forename: Søren Dinesen
authors.initials: SD
authors.lastname: Ostergaard
mesh_terms: D032921:Consensus; D003718:Denmark; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry; D011618:Psychotic Disorders / Q000188:drug therapy / Q000628:therapy*; D011795:Surveys and Questionnaires