Abstract. OBJECTIVE: It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone. METHOD: In a multi-center RCT, 122 patients (18-65 years) with DSM-IV-TR psychotic major depression and HAM-D-17 > or = 18 were randomized to 7 weeks imipramine (plasma-levels 200-300 microg/l), venlafaxine (375 mg/day) or venlafaxine-quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM-D-17. Secondary outcomes were response on CGI and remission (HAM-D-17). RESULTS: Venlafaxine-quetiapine was more effective than venlafaxine with no significant differences between venlafaxine-quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern. CONCLUSION: That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine-quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.

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Keywords Adolescent, Adult, Affective Disorders, Psychotic/*drug therapy, Aged, Antidepressive Agents, Tricyclic/therapeutic use, Antipsychotic Agents/therapeutic use, Cyclohexanols/*therapeutic use, Depressive Disorder/*drug therapy, Dibenzothiazepines/*therapeutic use, Double-Blind Method, Drug Administration Schedule, Drug Dosage Calculations, Drug Therapy, Combination, Female, Humans, Imipramine/*therapeutic use, Male, Middle Aged, Remission Induction, Serotonin Uptake Inhibitors/therapeutic use, Severity of Illness Index, Treatment Outcome, Young Adult
Persistent URL dx.doi.org/10.1111/j.1600-0447.2009.01464.x, hdl.handle.net/1765/23104
Journal Acta Psychiatrica Scandinavica
Wijkstra, J, Burger, H, van den Broek, W.W, Birkenhäger, T.K, Janzing, J.G.E, Boks, M.P.M, … Nolen, W.A. (2010). Treatment of unipolar psychotic depression: a randomized, double-blind study comparing imipramine, venlafaxine, and venlafaxine plus quetiapine. Acta Psychiatrica Scandinavica, 121(3), 190–200. doi:10.1111/j.1600-0447.2009.01464.x