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 .
Venlafaxine versus fluvoxamine in the treatment of delusional depression: a pilot double-blind controlled study.
BACKGROUND Previous studies have reported the efficacy of selective serotonin reuptake inhibitors as monotherapy in the treatment of delusional depression . The clinical efficacy of venlafaxine , a serotonin-norepinephrine reuptake blocker , has been demonstrated in the treatment of patients with moderate-to-severe depression , but , to date , no evidence is available about its use in depressed patients with psychotic features . METHOD Under double-blind conditions , 28 hospitalized patients who met DSM-IV criteria for major depression , severe with psychotic features , were r and omly assigned to receive fluvoxamine or venlafaxine , 300 mg/day , for 6 weeks . Severity was evaluated using the Hamilton Rating Scale for Depression ( HAM-D ) and the  Dimensions of Delusional Experience Rating Scale ( DDERS ) administered at baseline and every week thereafter . Side effects were also recorded . Clinical response was defined as a reduction of the scores in the 21-item HAM-D to 8 or below and in the DDERS to 0 . RESULTS At study completion , the response rates were 78.6 % ( N = 11 ) and 58.3 % ( N = 7 ) for fluvoxamine and venlafaxine , respectively . No significant difference was found between drugs ( Fisher exact test , p = .40 ) . Analysis of covariance on HAM-D scores did not reveal a significantly different decrease of depressive symptomatology between the 2 treatment groups ( p = .14 ) . Treatment response appeared to be unrelated to the demographic and clinical characteristics recorded . The overall safety profile of both fluvoxamine and venlafaxine was favorable . CONCLUSION The results of this pilot double-blind trial show that fluvoxamine is useful in the treatment of delusional depression and suggest that venlafaxine may also be an effective compound in the treatment of this disorder . The latter finding , although promising , warrants further replication in a larger sample of patients
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 .