Psychotic Depression: Advances in Pharmacological and Psychotherapeutic Treatment

• DOI: https://doi.org/10.22533/at.ed.15953025180913

• Palavras-chave: Psychotic depression; Antidepressants; Antipsychotics; Combination therapy; Cognitive behavioral therapy.

• Keywords: Psychotic depression; Antidepressants; Antipsychotics; Combination therapy; Cognitive behavioral therapy.

• Abstract:

  Psychotic depression (PD) is a severe subtype of major depressive disorder characterized by delusions and/or hallucinations, and is associated with a worse clinical prognosis, increased risk of suicide, and high relapse rates. The treatment of choice recommended by the guidelines is the combination of antidepressants with antipsychotics, or electroconvulsive therapy (ECT) in severe or refractory cases. The combination of selective serotonin reuptake inhibitors (SSRIs) with second-generation antipsychotics has greater efficacy and tolerability. Electroconvulsive therapy remains the most effective treatment in severe cases. Despite the focus on pharmacotherapy, psychotherapeutic interventions such as cognitive behavioral therapy (CBT) and psychoeducation have shown important benefits as adjuvants. In addition, emerging therapies, such as the use of psilocybin and cannabidiol, are being investigated, although there is still no robust evidence for their application in PD. There is an urgent need for more clinical studies evaluating maintenance treatments, integrated strategies, and long-term functional outcomes.