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 comparison of nortriptyline plus perphenazine versus nortriptyline plus placebo in the treatment of psychotic depression in late life.
OBJECTIVE To conduct the first r and omized study comparing the efficacy of an antidepressant alone versus an antidepressant plus a neuroleptic in the treatment of late-life psychotic depression . METHOD The efficacy of nortriptyline plus placebo versus nortriptyline plus perphenazine was compared in 36 patients aged 50 years or older presenting with a major depressive episode with psychotic features ( DSM-III-R criteria ) . Patients were started openly on nortriptyline treatment titrated to therapeutic levels . They were then r and omly assigned under double-blind conditions to addition of perphenazine or placebo . Outcomes were compared in the 2 treatment groups using measures including the Hamilton Rating Scale for Depression ( HAM-D ) and the Brief Psychiatric Rating Scale ( BPRS ) ; side effects were assessed with the Geriatric Movement Disorder Assessment . RESULTS Both treatments were well tolerated . Of the 36 r and omly assigned patients , 2 ( 1 in each group ) dropped out due to treatment-related adverse effects . Four additional patients dropped out for administrative reasons . Thirty patients received nortriptyline for at least 4 weeks combined with either perphenazine ( N = 14 ) or placebo ( N = 16 ) for at least 2 weeks ( median = 9 weeks ) . There was no significant difference between the completers in the 2 treatment groups when comparing their scores on the HAM-D , the BPRS , its psychoticism subscale , or any side effects measure . Rates of response ( defined as resolution of both depression and psychosis ) did not differ significantly in the 2 groups ( nortriptyline-plus-perphenazine group , 50 % vs. nortriptyline-plus-placebo group , 44 % ) . CONCLUSION When treating older patients with psychotic depression , the addition of a moderate dose of a traditional neuroleptic to a tricyclic antidepressant was well tolerated but did not improve efficacy . This finding supports existing data suggesting that the pathophysiology ( and thus the required treatment ) of psychotic depression may be different early and late in life
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 .