Antidepressant and antipsychotic treatment of Psychotic Major Depression in a British mental healthcare setting

Background Evidence from treatment trials shows that the most effective pharmacological treatment for Psychotic Major Depression (PMD) is combined antidepressant and antipsychotic pharmacotherapy. Aim This study investigates the use of antidepressant and antipsychotic treatment for PMD in clinical practice and examines how treatment profiles correlate with demographic and clinical symptoms. Method Anonymised electronic health records of 2,837 individuals with PMD were followed up for 12-months post-diagnosis in a historic open cohort design. The use of antidepressants and antipsychotics, alone or in combination, were described using frequency statistics. Demographic and clinical characteristics associated with each treatment were assessed using logistic regression analyses. Results Antidepressant and antipsychotic combination pharmacotherapy was the most used treatment for PMD with 69.9% users, compared to antidepressant monotherapy (10.9%) and antipsychotic monotherapy (10.3%). The remaining 8.9% of individuals did not receive antidepressant or antipsychotic treatment. The presence of delusions was strongly associated with the use of antipsychotics, both alone (odds ratio =3.99, 95% confidence intervals = 2.72-5.83, p<.001) and in combination with antidepressants (OR = 2.7, 95% CI = 2.09-3.67, p<.001), rather than antidepressant treatment alone. Conclusions Combined antidepressant and antipsychotic pharmacotherapy is the most common treatment of PMD in clinical practice, showing that clinical practice is in line with evidence from treatment research.

Automated summary

This study investigates the use of antidepressant and antipsychotic treatment for Psychotic Major Depression (PMD) in clinical practice and examines how treatment profiles correlate with demographic and clinical symptoms. The results showed that combined antidepressant and antipsychotic pharmacotherapy is the most common treatment for PMD in clinical practice, in line with evidence from treatment research.