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 .
Limited efficacy of ketoconazole in treatment-refractory major depression.
The authors examined the efficacy of ketoconazole in 16 adults with treatment-refractory major depressive disorder . Subjects participated in a 6-week , double-blind , placebo-controlled trial . Assessment s of mood were made using the Hamilton Rating Scale for Depression ( HAM-D ) , the Beck Depression Inventory ( BDI ) , and the Clinical Global Impression Scale ( CGI ) . Results showed that none of eight patients r and omly assigned to receive placebo and two of eight patients r and omly assigned to receive ketoconazole met criteria for response . As a group , patients assigned to receive ketoconazole showed no significant reductions in HAM-D , BDI , or CGI scores during the 6-week trial compared with those receiving placebo . These findings suggest a limited efficacy for ketoconazole in patients with treatment-refractory major 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 .