How Long Should Patients With Psychotic Depression Stay on the Antipsychotic Medication?
Abstract
Background Patients who have major depression with psychotic features have greater morbidity and mortality than patients with nonpsychotic major depression. In particular, relapse and recurrence have been reported to occur more frequently in patients with psychotic depression than nonpsychotic depression. Despite the frequent relapse and recurrence in major depression with psychotic features, there are few studies of the efficacy of continuation and maintenance treatments. Method Forty patients with a diagnosis of unipolar DSM-III-R major depression with psychotic features were treated with fluoxetine and perphenazine for 5 weeks after granting written informed consent. The patients who responded to treatment continued to receive the combination for an additional 3 months. If a patient was stable for 4 months on treatment with the combination, the patient was then gradually tapered off perphenazine treatment. For patients who exhibited impending relapse, perphenazine was restarted. Impending relapse was defined as any of the following: (1) symptoms meeting DSM-IV criteria for major depressive disorder (with or without psychotic features), (2) a total score of > or = 17 on the HAM-D, or (3) the presence of any psychotic symptoms. After 1 year of taking fluoxetine, patients were tapered off fluoxetine treatment. Data were gathered from 1992 to 1997. Results Thirty patients responded to the initial 5 weeks of treatment with perphenazine and fluoxetine. After taper of perphenazin…
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Psychotropic medications have known limitations, such as inadequate or incomplete response, relapse, and ongoing functional impairment.
“However, the limitations of psychotropic medications, including inadequate or incomplete response, relapse, and continued functional impairment, are well known.7,8”
From Acceptance-based Behavior Therapy for Depression With Psychosis (2015) · cites this paper as [8]
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- Authors
- Rothschild, A. J., & Duval, S. E.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2003-04-15
- Volume
- 64
- Issue
- 4
- Pages
- 390-396
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2049744486
- Cited by
- 46
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 3 · 2018: 3 · 2016: 4 · 2015: 1 · 2014: 1 · 2013: 5 · 2012: 3
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- National Institutes of Health (7r29mh047457-06)
- National Institute of Mental Health (MH-47457)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- psychotic depression, antipsychotic drugs, perphenazine, fluoxetine, relapse prevention, relapse risk factors, episode duration
- MeSH terms
- Acute Disease, Adult, Affective Disorders, Psychotic, Clinical Protocols, Depressive Disorder, Drug Administration Schedule, Drug Therapy, Combination, Female, Fluoxetine, Humans, Male, Middle Aged, Perphenazine, Prospective Studies, Psychiatric Status Rating Scales, Time Factors, Antipsychotic Agents, Secondary Prevention
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