Overview
Severe recurrent major depression is characterized by multiple distinct episodes of major depressive disorder that significantly impair functioning. Patients with this condition are at high risk for future episodes and may require ongoing treatment to prevent relapse and recurrence.Diagnosis
Diagnosis is based on established criteria for major depressive disorder, with a history of at least two or more distinct depressive episodes.Management
Maintenance treatment aims to prevent relapse and recurrence in patients with psychotic depression 1.
Combination therapy with antidepressant (AD) and antipsychotic (AP) agents was compared to AD monotherapy in patients with psychotic unipolar depression 1.
One large study reported a statistically significant advantage of AD + AP compared with AD monotherapy for psychotic depression 1.
A meta-analysis of three studies comparing AD + AP combination therapy with AD monotherapy (195 patients, 56 events) did not show a statistically significant difference 1.
Electroconvulsive therapy (ECT) in combination with ADs was also compared to AD monotherapy in the context of psychotic depression 1.Key Recommendations
Maintenance treatment should be considered to prevent relapse and recurrence in patients with psychotic depression 1. (Evidence: Moderate)
The combination of antidepressant and antipsychotic therapy may be beneficial for psychotic depression, although evidence from meta-analysis is not statistically significant 1. (Evidence: Moderate)
Combination therapy with electroconvulsive therapy and antidepressants is another option for maintenance treatment in psychotic depression 1. (Evidence: Weak)References
1 Al-Wandi A, Holmberg C, Landén M, Nordenskjöld A. A systematic review and meta-analysis of maintenance treatment for psychotic depression. Nordic journal of psychiatry 2022. link