Algorithms for the pharmacotherapy psychotic depression.

Psychotic depression is reported and requires different pharmacological treatment from other mood disorders, however, sufficient studies to guide us in selecting successful treatment strategies have not been performed. In this study, algorithm for the treatment of psychotic depression was developed by the Japan Psychopharmacology Algorithm Project. The following three issues are emphasized: (1) risk of suicide; (2) agitation; and (3) oral intake ability. When patients show a high risk of suicide and/or agitation, prompt treatment strategies, such as tricyclic antidepressant (TCA)/neuroleptics therapy or electroconvulsive therapy (ECT), are necessary. If patients show no suicidal risk without agitation, TCA therapy is recommended. ECT is recommended as the first choice when the symptoms are severe or when there is an inability of oral intake.