Background Psychotic depression is a severe disease with a lifetime prevalence between 0.35 and 1%. Several guidelines suggest electroconvulsion therapy (ECT) as first choice treatment, however, in practice a pharmacological approach is often used first.
Aim To offer an overview of scientific literature concerning the pharmacotherapeutic treatment of psychotic depression.
Method We searched ‘Pubmed’ for Dutch or English articles, published after 1999.
Results The search strategy produced 26 articles, of which 6 were excluded because of a too small study population. In the references of used literature 4 more articles were witheld. 24 articles were included. Despite the severity of the disease and the high prevalence, the research regarding treatment of psychotic depression is limited. Besides ECT, we consider combination therapy with an antidepressant and an antipsychotic as the most supported treatment, for a duration of at least four months. After four months tapering off the antipsychotic can be considered.
Conclusion Based on the discussed research, it’s difficult to arrive at conclusions regarding the choice of products. Olanzapine or quetiapine were investigated the most in combination with an SSRI. The combination of an SNRI (venlafaxine) and quetiapine shows good results. The distinct effect of treatment with a TCA calls for further investigation.