Psychotic depression is a distinct clinical entity in that its response
to tricyclic antidepressants is poor but its response to tricyclic
antidepressant-antipsychotics is better. The authors report the favorable
outcome of four patients with psychotic depression treated with amoxapine,
a derivative of the antipsychotic loxapine. The elevation of serum
prolactin during treatment in three patients suggests that postsynaptic
dopamine blockade occurs with amoxapine treatment. This might account for
the efficacy of amoxapine in psychotic depression.