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 .
Faster onset of action of fluvoxamine in combination with pindolol in the treatment of delusional depression: a controlled study.
This double-blind , controlled study was undertaken to investigate whether the addition of pindolol could improve the therapeutic response to fluvoxamine of depressed patients with psychotic features . After a 1-week placebo run-in period , 72 patients received fluvoxamine  300 mg/day in combination with placebo or pindolol 7.5 mg/day . At study completion , 28 ( 80 % ) of 35 patients treated with fluvoxamine plus placebo and 29 ( 80.5 % ) of 36 patients treated with fluvoxamine plus pindolol were categorized as responders ( reduction of their score on the 21-item Hamilton Rating Scale for Depression to 8 or less and on the Dimension for the Delusional Experience Rating Scale to 0 ) . In the third and fourth weeks , the response rates were significantly superior in the fluvoxamine plus pindolol group ( p = 0.0001 , p = 0.023 , respectively ) . Treatment response seemed to be unrelated to the demographic and the clinical characteristics recorded . No significant difference was found comparing plasma levels of fluvoxamine between groups , thus excluding a pharmacokinetic interaction . Other than mild nausea and sedation in a few patients , treatments were well tolerated . No medically significant adverse events occurred . Depressed patients with psychotic features who were administered pindolol experienced a more rapid improvement during fluvoxamine treatment . Thus , the combination of fluvoxamine with pindolol may be a useful pharmacologic strategy in the treatment of this disorder . A rapid clinical response in such patients is of relevance in clinical practice as well as in economic fields , given the direct and indirect costs of 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 .