Treatment Options for Psychotic Depression in Older People: Focused Literature review by New Zealand Psychogeriatric Team
- 1. The University of Otago Medical School, New Zealand
- 2. The Sackler School of Medicine, Tel-Aviv University, Israel
Abstract
Background: Psychotic major depressive disorder (PMDD) is complex with poor prognosis, reported in 15% to 25% of episodes with higher rates amongst
older inpatients. There is little data on effective pharmacological treatment of PMDD.
Method: A critical review from a focused literature search was conducted. A literature search of controlled trials from: EMBASE (1970- ), MEDLINE (1950- )
and PsycINFO (1960-) was undertaken. Two authors (SP and YB) independently extracted the data.
Results: Of 386 studies 13 RCTs encompassing1, 359 participants fulfilled inclusion criteria. Of these 556 (41%) were participants in mifepristone trials
that proved negative. Only 2 RCT included older patients. Findings suggest combining antidepressant and antipsychotic medications is advantageous in PMDD.
This is supported by case series and uncontrolled studies. The practice of antidepressant monotherapy cannot be supported in older adults.
Conclusions: Further studies of pharmacological treatment of PMDD in older people are sorely needed.