Advances in the Treatment of Psychotic Depression

  • Amber R. Thompson
  • Aekta Malhotra
  • Anthony J. RothschildEmail author
Schizophrenia and Other Psychotic Disorders (J Csernansky, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Schizophrenia and Other Psychotic Disorders


Purpose of review

Our aim was to update the current understanding of effective treatment strategies for major depression with psychotic features (MDPSY).

Recent findings

Most treatment guidelines recommend either the combination of an antidepressant with an antipsychotic or electroconvulsive therapy (ECT) for the treatment of an acute episode of MDPSY. The optimal maintenance treatment after a person responds to either the antidepressant/antipsychotic combination or ECT is unclear particularly as it pertains to length of time the patient needs to take the antipsychotic medication. Further investigation into possible uses of ketamine, lithium carbonate, mifepristone, minocycline, and rTMS may produce possible new treatments in the future.


Unfortunately, there is no FDA-approved treatment for MDPSY. The combination of an antidepressant and antipsychotic is significantly more effective than either antidepressant monotherapy or antipsychotic monotherapy for the acute treatment of MDPSY.


Psychosis Depression Antidepressants Antipsychotics Lithium Electroconvulsive therapy 


Compliance with ethical standards

Conflict of interest

Dr. Rothschild has received grant or research support from Allergan, Janssen, the National Institute of Mental Health, Takeda, Eli-Lilly (medications for a NIH-funded clinical trial), Pfizer (medications for a NIH-funded clinical trial), and the Irving S. and Betty Brudnick Endowed Chair in Psychiatry; is a consultant to GlaxoSmithKline and Sanofi-Aventis; and has received royalties for the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT)®; Clinical Manual for the Diagnosis and Treatment of Psychotic Depression, American Psychiatric Press, 2009; The Evidence-Based Guide to Antipsychotic Medications, American Psychiatric Press, 2010; The Evidence-Based Guide to Antidepressant Medications, American Psychiatric Press, 2012, and Up-to-Date®.

Drs. Malhotra and Thompson report no potential conflict of interest relevant to this article.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Amber R. Thompson
    • 1
  • Aekta Malhotra
    • 1
  • Anthony J. Rothschild
    • 1
    Email author
  1. 1.Department of Psychiatry, Center for Psychopharmacological Research and TreatmentUniversity of Massachusetts Medical School and UMass Memorial HealthcareWorcesterUSA

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