Abnormalities in protein kinase A (PKA) and Rap1 have recently been reported in depressed patients. The aim of the present study was to investigate the levels of these proteins in platelets from untreated unipolar and bipolar depressed patients with psychotic features. The levels PKA and Rap1 were assessed by Western blot analysis and immunostaining in 37 drug-free patients and 29 healthy subjects. Both unipolar and bipolar patients with psychotic depression have significantly lower levels of platelet regulatory type I and higher levels of catalytic subunits of PKA than controls, whereas the levels of regulatory type II were higher only in psychotic unipolar patients. No significant differences were found in the immunolabeling of both Rap1 and actin among groups. These findings support the idea that besides nonpsychotic depression, abnormalities of PKA could be linked, albeit in a somewhat different way, with psychotic depression. Molecular Psychiatry ( Several studies have shown that dysfunctions in PKA and some of its subtrates such as CREB and Rap1 are associated with affective disorders. 1-9 Delusional or psychotic depression is a severe disorder affecting approximately 20% of depressed patients and 0.6% of the general population. 10 According to DSM-IV criteria, it is defined by the presence of a major depressive episode accompanied by delusions and/or hallucinations that occurs in patients suffering from unipolar or bipolar disorder. 11 Although several biological differences were reported between psychotic and nonpsychotic depression, [12][13][14][15][16] there is at present no information on the possible involvement of the cAMP signaling pathway in psychotic depression. In this study we examined the levels of PKA and Rap1 in platelets from drugfree psychotic depressed patients and healthy subjects. We demonstrated that both unipolar and bipolar patients with psychotic depression have significantly lower levels of regulatory type I and higher levels of catalytic subunits of PKA than controls, whereas the levels of regulatory type II were higher only in unipolar patients. No significant differences were found in the immunolabeling of both Rap1 and actin among groups.These findings further support the idea that besides nonpsychotic depression, abnormalities of cAMP signaling pathway could be linked, albeit in a somewhat different way, with psychotic depression. The PKA subunits, Rap1 and actin were assessed by Western blot analysis, immunostaining and computerassisted imaging in whole platelet proteins from 37 drug-free depressed patients with psychotic features and 29 healthy subjects. Figure 1 illustrates representative immunoblots of regulatory type I (RI), type II (RII) and catalytic (C) subunits of PKA, Rap1 and actin in platelets from bipolar and unipolar patients with psychotic features and control subjects.As determined by the analysis of variance, the immunolabeling of the RI subunit of PKA was significantly different among groups (F 2,61 = 5.90; P = 0.004). Post hoc comparisons showed that both bi...