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 .
Efficacy and Safety of Mifepristone for the Treatment of Psychotic Depression
Open-label studies and r and omized clinical trials have suggested that mifepristone may be effective for the treatment of major depression with psychotic features ( psychotic depression ) . A recent study reported a correlation between mifepristone plasma concentration and clinical response . The current study aim ed to evaluate the safety and efficacy of mifepristone and , secondarily , to test whether response was significantly greater among patients with mifepristone plasma concentrations above an a priori hypothesized threshold . A total of 433 patients who met criteria for psychotic depression were r and omly assigned to receive 7 days of either mifepristone ( 300 , 600 , or 1200 mg ) or placebo . Response was defined as a 50 % reduction in psychotic symptoms on both days 7 and 56 . Cochran-Mantel-Haenszel tests compared ( 1 ) the proportion of responders among patients assigned mifepristone versus placebo and ( 2 ) the proportion of responders among the subset of patients with plasma concentrations greater than 1660 ng/mL versus placebo . Mifepristone was well tolerated at all 3 doses . The proportion of responders r and omized to mifepristone did not statistically differ from placebo . Patients with trough mifepristone plasma concentrations greater than 1660 ng/mL were significantly more likely to have a rapid and sustained reduction in psychotic symptoms than those who received placebo . The study failed to demonstrate efficacy on its primary end point . However , the replication of a statistically significant linear association between  mifepristone plasma concentration and clinical response indicates that mifepristone at sufficient plasma levels may potentially be effective in rapidly and durably reducing the psychotic symptoms of patients with 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 .