Major Psychotic Depression Treatment

Psychotic depression is a very severe form of depression characterized by the presence of psychotic symptoms such as hallucinations or delusions in addition to typical symptoms of a depressive episode. Treatment for psychotic depression can be quite effective, provided that the patient complies with a treatment regimen. After an individual recovers from an acute psychotic depressive episode, it is often necessary to stay on medication for a period of time in order to prevent a recurrence.

Antidepressant Medications

• Antidepressant medications are commonly prescribed to control depressive symptoms such as fatigue, feelings of worthlessness or guilt, depressed mood, apathy and lack of interest in pleasurable activities. Although there are several different groups of antidepressant medications, the Mayo Clinic Medical Center notes that most patients are given one of the selective seritonin reuptake inhibitors (SSRIs), such as fluoxetine or fluvoxamine, as a first line of treatment, as they have a relatively low side effect profile. When these are not effective, doctors may choose to try a different SSRI or move on to the older types of antidepressants, tricyclics or monoamine oxidase inhibitors (MAOIs).

Mood Stabilizers

• For individuals who experience drastic mood swings, doctors may prescribe mood-stabilizing drugs. In an article for "Clinical Psychiatry News," Dr. Thomas Swartz notes that many people with psychotic depression respond better to treatment when it consists of both an antidepressant medication and a mood-stabilizing drug, such as lithium. Although lithium has been used for years and shown to be very effective in regulating mood shifts, it can build up to toxic levels relatively quickly, and patients who take the drug must be carefully monitored during treatment.

Antipsychotic Medications

• Antipsychotic medications are used to control psychotic symptoms, including hallucinations, delusions and obsessive thoughts. In the past, the most commonly used antipsychotics were Thorazine and Haldol. These medications produced serious side effects, called extrapyramidal effects, such as shaking, twitching, muscular rigidity and involuntary movements. These symptoms can persist even after treatment has been discontinued. The newer class of antipsychotic medications, called "atypical antipsychotics," carry a much lower side effect profile and include the drugs risperidone and olanzapine, among others.

Electroconvulsive Therapy (ECT)

• ECT can be quite effective in treating cases of severe psychotic depression. ECT involves introducing a controlled electrical shock to the brain while the patient is under anesthesia. This shock causes small seizures in the brain, which seem to serve to reset brain chemistry. Most patients who do not respond favorably to other types of treatments find at least moderate relief from symptoms through ECT.