Mental health articles

Patients with psychotic depression are the most severely depressed, and they respond poorly to antidepressants alone. Two treatments are effective: combined use of antidepressant and antipsychotic drugs, and electroconvulsive therapy. Combining some of the newer antidepressants, particularly the SSRIs, with antipsychotics should be done with caution as inhibition of the liver cytochrome enzymes can raise the plasma concentrations of both drugs, so monitoring may be needed.

Electroconvulsive therapy is an older treatment than antidepressant drugs. It is almost exclusively a hospital-based treatment, and most patients remain as inpatients during the course of treatment. It is particularly effective for severely depressed patients who are either deluded or have marked psychomotor retardation.

Treatment entails administering an electric charge to the head of a patient under a general anaesthetic in order to produce a generalised fit. Memory impairment may be reduced by unilateral compared to bilateral administration. From the patients’ point of view, they will have a general anaesthetic twice weekly for three to four weeks and experience a mild transient confusional state for an hour or so after each treatment.

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Tags: depression, psychotic depression, treatment