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 .
The Pharmacological Treatment of Delusional Depression: Part II
This study investigated the pharmacological treatment of delusional depressives by assigning patients on a r and om double-blind basis to amitriptyline ( AT ) alone , perphenazine ( PER ) alone , or AT + PER . As reported in an earlier paper , the combination of AT + PER was the superior treatment with a response rate of 78 % compared with 41 % for AT alone and 19 % for PER alone . This difference is both clinical ly and statistically significant ( p < 0.01 ) . In this second article , the authors report that the patients on AT + PER  had higher plasma levels of AT and its pharmacologically active metabolite nortriptyline ( NT ) than the patients on  AT alone . Although the response rate had a direct relationship to AT + NT plasma levels , an analysis of variance showed that the group of patients treated with AT + PER still had a significantly higher response rate , even after controlling for the plasma levels of AT + NT ( p < 0.05 ) . There was also a correlation between PER plasma levels and clinical response
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 .