Some evidence indicates that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or placebo .
Evidence is limited for treatment with an antidepressant alone or with an antipsychotic alone
BACKGROUND Evidence is limited regarding the most effective pharmacological treatment for psychotic depression :  combination of an antidepressant plus an antipsychotic , monotherapy with an antidepressant or monotherapy with an antipsychotic .
This is an up date of a review first published in 2005 and last up date d in 2009 .
OBJECTIVES 1 .
To compare the clinical efficacy of pharmacological treatments for patients with an acute psychotic depression :  antidepressant monotherapy , antipsychotic monotherapy and the combination of an antidepressant plus an antipsychotic , compared with each other and /or with placebo.2 .
To assess whether differences in response to treatment in the current episode are related to non-response to prior treatment .
Factors associated with non-completion in a double-blind randomized controlled trial of olanzapine plus sertraline versus olanzapine plus placebo for psychotic depression
High rates of attrition have been reported in r and omized controlled trials of patients with severe psychiatric illness , including psychotic depression ( MDpsy ) . The purpose of this study is to examine factors associated with overall attrition and with subtypes of attrition in the Study of the Pharmacotherapy of Psychotic Depression ( STOP-PD ) . Secondary analysis of data collected in a multi-site , r and omized , placebo-controlled trial . Clinical services of academic hospitals . Participants comprised 259 persons with MDpsy , aged 18 - 93 years . The intervention consisted of the r and om allocation to 12 weeks of treatment of either olanzapine plus sertraline or olanzapine plus placebo . Demographic and clinical variables associated with overall non-completion and sub-types of non-completion of r and omized treatment . One hundred and seventeen ( 45.2 % ) subjects did not complete 12 weeks of r and omized treatment . In a logistic regression analysis , inpatient entry status , olanzapine monotherapy , and higher cumulative medical burden were statistically significant independent predictors of overall non-completion . In a multinomial logistic regression model that examined predictors of subtypes of non-completion , subjects who entered the study as an inpatient were less likely to complete because of inadequate efficacy as determined by the investigator , and older subjects were less likely to complete because of poorer tolerability . Subjects who were assigned to olanzapine monotherapy , younger subjects , and subjects who entered the study as in patients were less likely to complete because of reasons other than efficacy or tolerability . Underst and ing factors that contribute to premature discontinuation in studies of MDpsy , and to the specific reasons for attrition , has the potential to improve the management of this disorder , as well as improve the design of future clinical trials of MDpsy
Some evidence indicates that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or placebo .
Evidence is limited for treatment with an antidepressant alone or with an antipsychotic alone
BACKGROUND Evidence is limited regarding the most effective pharmacological treatment for psychotic depression :  combination of an antidepressant plus an antipsychotic , monotherapy with an antidepressant or monotherapy with an antipsychotic .
This is an up date of a review first published in 2005 and last up date d in 2009 .
OBJECTIVES 1 .
To compare the clinical efficacy of pharmacological treatments for patients with an acute psychotic depression :  antidepressant monotherapy , antipsychotic monotherapy and the combination of an antidepressant plus an antipsychotic , compared with each other and /or with placebo.2 .
To assess whether differences in response to treatment in the current episode are related to non-response to prior treatment .