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 .
A Double-Blind, Randomized Study of Olanzapine and Olanzapine/Fluoxetine Combination for Major Depression With Psychotic Features
Abstract : The purpose of this study was to compare the efficacy and safety of olanzapine ( OLZ ) monotherapy and an olanzapine/fluoxetine combination ( OFC ) with placebo ( PLA ) for unipolar major depression with psychotic features . Under a single protocol , two 8-week , double-blind trials were conducted at 27 sites . Patients ( n = 124 trial 1 , n = 125 trial 2 ) were r and omized to 1 of 3 treatment groups : OLZ ( 5 to 20 mg/d ) , PLA , or OFC ( olanzapine 5 to 20 mg/d + fluoxetine 20 to 80 mg/d ) . The primary outcome measure was the 24-item Hamilton Depression Rating Scale total score . For trial 1 , endpoint improvement for the OLZ group ( −14.9 ) was not significantly different from the PLA or OFC groups . The OFC group had significantly greater endpoint improvement ( −20.9 ) than the PLA group ( −10.4 , P = 0.001 ) ; this significant difference was present within 7 days of therapy and maintained at every subsequent visit . The OFC group also had significantly higher response rate ( 63.6 % ) than the PLA ( 28.0 % , P = 0.004 ) or OLZ ( 34.9 % , P = 0.027 ) groups . For trial 2 , there were no significant differences among treatment groups on the 24-item Hamilton Depression Rating Scale total scores or response rates . The combination exhibited a comparable safety profile with OLZ monotherapy and no significant increases in extrapyramidal symptoms compared with placebo . Patients with major depression with psychotic features treated with OLZ monotherapy did not demonstrate significant depressive symptom improvement compared with placebo in either trial ; however , an olanzapine/fluoxetine combination was associated with significant improvement compared with placebo in one trial and was well tolerated
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 .