Treatment of unipolar psychotic depression: a randomized, double-blind study comparing imipramine, venlafaxine, and venlafaxine plus quetiapine

J Wijkstra, H Burger, W.W. van den Broek, T.K. Birkenhager, JGE Janzing, MPM Boks, Jan Bruijn, MLM van der Loos, LMT Breteler, GMGI Ramaekers, RJ Verkes, WA Nolen

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Abstract

Objective: It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone. Method: In a multi-center RCT, 122 patients (18-65 years) with DSM-IV-TR psychotic major depression and HAM-D-17 >= 18 were randomized to 7 weeks imipramine (plasma-levels 200-300 mu g/l), venlafaxine (375 mg/day) or venlafaxine-quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM-D-17. Secondary outcomes were response on CGI and remission (HAM-D-17). Results: Venlafaxine-quetiapine was more effective than venlafaxine with no significant differences between venlafaxine-quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern. Conclusion: That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine-quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.
Original languageUndefined/Unknown
Pages (from-to)190-200
Number of pages11
JournalActa Psychiatrica Scandinavica
Volume121
Issue number3
DOIs
Publication statusPublished - 2010

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