Psychotic depression

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Because there are also some data that concurrent use of antidepressants can lead to rapid cycling in vulnerable patients, these agents may best be cautiously used on an as-needed basis or as adjuncts when there are early signs of breakthrough depressive, psychotic, or anxious symptoms. In particular, antidepressants do not prevent manic episodes, and may even precipitate them. The fact that many patients on antidepressants experience a manic phase, however, could be coincidental, rather than drug-induced. To definitively answer this question, we need to show that the number who switch to mania is higher on, as opposed to off, antidepressant therapy. Given these concerns, however, we advocate the initial use of a mood stabilizer alone to lessen the chance of a switch to mania in bipolar depressed patients. If this is insufficient, a mood stabilizer should be used concurrently with an antidepressant. 

The affective and other behavioral disturbances category of adverse drug reactions included Depression, Psychotic Depression, Emotional lability, Euphoria, Hostility, Personality disorder, and Decreased libido. ... 

Gastrointestinal Nausea, vomiting Neurologic Fatigue, insomnia, anesthesia Cardiovascular Bradyarrhythmia, hypotension Respiratory Asthma, bronchospasm Dermatologic Dermatitis, pruritus, urticaria Psychiatric Depression, psychotic disorder... 

Psychiatric Anxiety, irritability, aggressive behavior, depression, psychotic disorders, suicide... 

Mood stabilizers or atypical antipsychotics for bipolar depression, psychotic... 

Mood stabilizers or atypical antipsychotics tor bipolar depression, psychotic depression, treatment-resistant depression, or treatment-resistant anxiety disorders... 

Fluoxetine and other antidepressants may be effective augmenting agents to olanzapine for bipolar depression, psychotic depression, and for unipolar depression not responsive to antidepressants alone (e.g., olanzapine-fluoxetine combination)... 

Inquire about the preceding symptoms from the caregivers, and address any concerns they may have with specific attention to sleep disorders, depression, psychotic features, and dyskinesias that may not be apparent to the patient. 

Noncognitive Depression, psychotic symptoms (hallucinations and delusions), behavioral disturbances (physical and verbal aggression, motor hyperactivity, uncooperativeness, wandering, repetitive mannerisms and activities, and combativeness)... 

Few randomized controlled trials have been done to evaluate different approaches for the treatment of acute and recurrent bipolar depression. Nonpharmacologic treatment that may have augmenting effects include phototherapy for seasonal-pattern depression and sleep deprivation for rapid cycling." The use of ECT for severe episodes of mania/mixed episodes, depression, psychotic features (e.g., hallucinations or delusions), or rapid cycling is still considered the best acute treatment approach for those patients who do not respond to first-line mood stabilizers such as lithium and valproate. " ... 

It is indicated in the treatment of depressive episodes associated with bipolar disorder. A combination of an antipsychotic drug and an antidepressant may be useful in some cases, especially in depressed psychotic patients, or in cases of agitated major depression with psychotic features. The first combination antipsychotic/antidepressant (olanza-pine/fluoxetine Symbyax) was recently FDA approved in the United States for treatment of depressive episodes associated with bipolar disorder. However, antidepressants and stimulants are unlikely to reduce apathy and withdrawal in schizophrenia, and they may induce clinical worsening in some cases. Adjunctive addition of lithium or an antimanic anticonvulsant, such as carbamazepine, may add benefit in some psychotic patients with prominent affective, aggressive, or resistant symptoms. 

Amoxapine is a heterocyclic antidepressant. It is a metabolite of the antipsychotic drug, loxapine, and thus has the additional action of dopaminergic blockade. This action makes it a potentially useful therapy in depressed psychotic patients. 

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