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 .
Outcome in delusional depression comparing trimipramine monotherapy with a combination of amitriptyline and haloperidol--a double-blind multicenter trial.
BACKGROUND Patients with delusional depression are difficult to treat . The atypical antidepressant trimipramine was effective in a previous 4-week open label pilot study in patients with this disorder . The major neurobiological effect of trimipramine is the inhibition of the hypothalamic-pituitary-adrenocortical ( HPA ) system . In delusional depression HPA overactivity is more distinct than in other subtypes of depression . HPA suppression is thought to contribute to the action of trimipramine . METHODS In a double-blind , r and omized , placebo controlled multicenter trial we compared the effects of trimipramine monotherapy versus a combination of amitriptyline and haloperidol . Dosage was increased stepwise from 100 mg up to 400 mg trimipramine and from 100 mg up to 200 mg amitriptyline combined with 2 mg up to 7.5 mg haloperidol . The average dose of trimipramine was higher than that of amitriptyline throughout the trial . During sixth week mean dosage ( + /-st and ard deviation ) were 356.1+/-61.2 mg trimipramine , 184.0+/-23.6 mg amitriptyline and 6.3+/-1.8 mg haloperidol . During six weeks psychometric assessment s were performed weekly . For HPA monitoring a dexamethasone/corticotropin-releasing hormone ( Dex/CRH ) test was performed before active medication and at the end of treatment . Additionally tolerability was monitored by ECG , EEG assessment of extrapyramidal symptoms and akathisia , clinical laboratory routine and recording of blood pressure and heart rate . Adverse events were documented . RESULTS 94 patients were enclosed into the study . The per protocol sample consisted of 33 patients of the trimipramine group and of 24 patients of the amitriptyline/haloperidol group . The decrease of the Hamilton depression ( HAMD ) score ( 24 items ) showed non-inferiority of trimipramine compared to amitriptyline/haloperidol . Twenty-eight patients ( 84.84 % ) in the trimipramine arm and 17 patients ( 70.83 % ) in the amitriptyline/haloperidol arm were responders ( HAMD < or=50 % ) . Remission ( HAMD<8 ) was found in 18 ( 54.55 % ) patients after trimipramine and in 11 ( 45.83 % ) patients after amitriptyline/haloperidol . No significant differences were found concerning response and remission . The cortisol and ACTH response in the Dex/CRH test decreased between days 1 and 42 in both groups . Serious side effects were not reported . CONCLUSION In all , trimipramine monotherapy appears to be an effective treatment in delusional depression
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 .