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 .
Resistance to antidepressant medications and short-term clinical response to ECT.
OBJECTIVE Traditionally , it has been widely assumed that the likelihood of response to ECT is independent of the adequacy of previous treatment with antidepressant medications . However , recent research has raised the possibility that medication-resistant patients with depression have a poorer clinical ECT outcome than patients who have not failed previous adequate medication trials . METHOD Medication resistance of 100 patients with primary , unipolar , nonpsychotic major depression was evaluated during the index episode with the Antidepressant Treatment History Form . Patients were recruited and treated with ECT at three sites ; st and ardized ECT and clinical assessment procedures were used . Clinical outcome was assessed immediately and 1 week after completion of the ECT course . RESULTS Patients who previously had failed one or more adequate antidepressant medication trials were less likely to respond to subsequent ECT than patients not known to be medication resistant . This finding held within each study site , whether clinical response was assessed categorically or in terms of the magnitude of symptomatic improvement and after the authors accounted for other potential predictors of clinical outcome . Resistance to heterocyclic antidepressants predicted poorer outcome after ECT , while resistance to selective serotonin reuptake inhibitors and monoamine oxidase inhibitors did not show significant predictive relations . CONCLUSIONS While a substantial percentage of medication-resistant patients respond to ECT , clinical outcome in this group is inferior to that of patients without established medication resistance . The predictive power of medication resistance is generalizable across diverse clinical setting s , particularly for heterocyclic antidepressants , which perhaps suggests an overlap in the mechanisms of actions of ECT and this medication class
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 .