Pharmacological treatment of psychotic depression

Psychotic depression is challenging to treat. Electroconvulsive therapy has long been recognised as an effective treatment,1 but for several reasons, including patient choice, pharmacotherapy is frequently used instead. Two pairwise meta-analyses2,3 have shown that the combination of an antidepressant plus an antipsychotic is more efficacious than either drug class alone in the acute treatment of psychotic depression. The rigorous network meta-analysis by Vincenzo Oliva and colleagues4 in this issue of The Lancet Psychiatry extends this line of enquiry by examining the efficacy and safety of specific drugs in the acute treatment of psychotic depression.