Drug treatment in delusional depression

Treatment of unipolar psychotic depression: The use of evidence in practice guidelines

“…Parker et al (1992) is mentioned by the Canadian and the Dutch guideline and Zanardi et al (1996) by the Canadian and the UK-Nice guideline. The following studies are mentioned by one guideline: Anton and Burch (1990), Bellini et al (1994), Zanardi et al (2000) and Mulsant et al (2001) by theUK-NICE guideline, Minter and Manderl (1979), Kaskey et al (1980), Charney and Nelson (1981), Brown et al (1982), Spiker et al (1982) by the Australian guideline, Bruijn et al (2001) by the Dutch guideline, Rothschild et al (1993) by the WFSBP guideline, Zanardi et al (1998) and by the Canadian guideline. A critical short overview of all the references is presented in Table II.…”

“…However, the guideline does not take into account the many methodological problems of all six studies. The only prospective RCT was the study of Spiker et al (1985) (the 1982 study of Spiker et al is part of that study); three studies were retrospective (Minter and Manderl 1979;Charney and Nelson 1981;Brown 1982); two studies used too low doses of a TCA and for only a very short treatment period (Kaskey 1980;Brown 1982); and one study included 30% patients with bipolar disorders Kaskey (1980). As already mentioned, based on ITT analysis, the Spiker et al (1985) study did not find combination treatment (AP'AD) to be superior to AD monotherapy.…”

“…monotherapy with a SSRI despite, according to the authors, there being level II evidence for this recommendation, while it advises using olanzapine, which, again according to their own classification, is supported by only level III evidence ). The Australian New Zealand guideline (2004) refers to six studies (Minter and Manderl 1979;Kaskey 1980;Charney and Nelson 1981;Brown 1982;Spiker 1982Spiker , 1985 in their conclusion that the treatment with a TCA plus an AP is superior to a TCA alone, indicated by a number needed to treat of 2 (!). However, the guideline does not take into account the many methodological problems of all six studies.…”

“…Responders with first treatments only: TCA 0/3 (0%), AP 2/4 (50%). Kaskey et al 1980 A retrospective study of 23 patients with depression and delusions, including 30% with bipolar disorder or schizoaffective disorder. Treatment was with imipramine 100 mg for more than 3 weeks (without blood level control), with an AP, or with the combination.…”

Convulsive and Drug Therapies of Depression

“…Some authors find that such patients respond well to BeT and suggest that the presence of somatic delusions in a patient with endogenous depression may be considered a primary indica tion for EeT. Other authors, however, question the conclusion and suggest that delusional depressed patients will improve with combined antipsy chotic and antidepressant drug therapy (44,53,54).…”