Pharmacological treatment for psychotic depression

In this Cochrane systematic review, researchers compared the clinical efficacy of pharmacological treatments for patients with acute psychotic depression to a placebo. They studied these treatments: 

• Antidepressant monotherapy 
• Antipsychotic monotherapy 
• Mifepristone monotherapy 
• Combination of an antidepressant plus an antipsychotic

Researchers also assessed whether differences in response to treatment in the current episode are related to non‐response to prior treatment.

Researchers found some evidence that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or a placebo. They found limited evidence to assess treatment with an antidepressant alone or with an antipsychotic alone. Evidence to assess the efficacy of mifepristone is lacking.

Further, researchers pointed out that psychotic depression is heavily under‐studied, limiting confidence in these conclusions.