OBJECTIVE: The adequacy of pharmacologic treatment received by patients
with psychotic major depression was evaluated. METHOD: The authors
systematically assessed the pharmacotherapy received by 187 depressed
patients before initiation of ECT and compared the medication trials of
those with psychotic (N = 53) and nonpsychotic (N = 134) depression.
RESULTS: Despite a median of four medication trials and median index
episode duration of 20 weeks, only two (4%) of the patients with psychotic
depression received at least one adequate pharmacotherapy trial. In
contrast, 70 (52%) of the patients with nonpsychotic depression received at
least one adequate trial. Twenty-five (47%) of the patients with psychotic
depression received either no neuroleptic treatment (N = 11) or treatment
for less than 3 weeks (N = 14). Only eight (15%) received a daily
neuroleptic dose higher than 200 mg of chlorpromazine equivalents.
CONCLUSIONS: These findings suggest that many patients with psychotic major
depression referred for ECT receive inadequate pharmacotherapy because of
either the absence or the inadequate use of neuroleptic medication.