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 .
Mifepristone versus Placebo in the Treatment of Psychosis in Patients with Psychotic Major Depression
BACKGROUND Abnormalities in the hypothalamic pituitary adrenal axis have been implicated in the pathophysiology of psychotic major depression ( PMD ) . Recent studies have suggested that the antiglucocorticoid , mifepristone might have a role in the treatment of PMD . The current study tested the efficacy of mifepristone treatment of the psychotic symptoms of PMD . METHODS 221 patients , aged 19 to 75 years , who met DSM-IV and SCID criteria for PMD and were not receiving antidepressants or antipsychotics , participated in a double blind , r and omized , placebo controlled study . Patients were r and omly assigned to either 7 days of mifepristone ( n = 105 ) or placebo ( n = 116 ) followed by 21 days of usual treatment . RESULTS Patients treated with mifepristone were significantly more likely to achieve response , defined as a 30 % reduction in the Brief Psychiatric Rating Scale ( BPRS ) . In addition , mifepristone treated patients were significantly more likely to achieve a 50 % reduction in the BPRS Positive Symptom Scale ( PSS ) . No significant differences were observed on measures of depression . CONCLUSION A seven day course of mifepristone followed by usual treatment appears to be effective and well tolerated in the treatment of psychosis in PMD . This study suggests that the antiglucocorticoid , mifepristone , might represent an alternative to traditional treatments of psychosis in psychotic 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 .