The British Journal of Psychiatry (2006) 188: 410-415. doi: 10.1192/bjp.bp.105.010470
© 2006 The Royal College of Psychiatrists
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REVIEW ARTICLE

Pharmacological treatment for unipolar psychotic depression

Systematic review and meta-analysis

JAAP WIJKSTRA, MD

Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre, Utrecht, The Netherlands

JEROEN LIJMER, PhD

Department of Psychiatry, Waterland Hospital, Purmerend, The Netherlands

FERDI J. BALK, MD

Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre, Utrecht, The Netherlands

JOHN R. GEDDES, MD, FRCPsych

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK

WILLEM A. NOLEN, PhD

University Medical Centre Groningen, Department of Psychiatry, Groningen, The Netherlands

Correspondence: Dr J. Wijkstra, University Medical Centre Utrecht, HP B01.206, PO Box 85500, 3508 GA, Utrecht, The Netherlands. E-mail: j.wijkstra{at}azu.nl

Declaration of interest J.W. and W.N. are currently conducting a randomised controlled trial in patients with unipolar psychotic depression, which is financially supported by Wyeth and AstraZeneca.These organisations also financially supported the literature search for this review.

Background The optimal pharmacological treatment of unipolar psychotic depression is uncertain.

Aims To compare the clinical effectiveness of pharmacological treatments for patients with unipolar psychotic depression.

Method Systematic review and meta-analysis of randomised controlled trials.

Results Ten trials were included in the review. We found no evidence that the combination of an antidepressant with an antipsychotic is more effective than an antidepressant alone.This combination was statistically more effective than an antipsychotic alone.

Conclusions Antidepressant monotherapy and adding an antipsychotic if the patient does not respond, or starting with the combination of an antidepressant and an antipsychotic, both appear to be appropriate options for patients with unipolar psychotic depression.However, clinically the balance between risks and benefits may suggest the first option should be preferred for many patients. Starting with an antipsychotic alone appears to be inadequate.


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