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Letters   |    
A Case of Psychotic Depression Successfully Treated With Sertraline as Monotherapy
Yoshito Mizoguchi, M.D.; Akira Monji, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:E12. doi:10.1176/appi.neuropsych.12120409
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Dept. of Neuropsychiatry, Faculty of Medicine, Saga University, Saga, Japan

Correspondence: Dr. Mizoguchi; e-mail: ymizo@pk2.so-net.ne.jp

Copyright © 2014 by the American Psychiatric Association

Extract

To the Editor: Patients with psychotic depression who present delusions and/or hallucinations in conjunction with depressive symptoms are often difficult to treat.1 For the treatment of acute episodes of psychotic depression, the combination of an antidepressant with an antipsychotic has shown greater efficacy than did the antidepressant alone.1 Monotherapy with sertraline, one of the selective serotonin reuptake inhibitors (SSRIs), is reported to be effective, but is not recommended for the treatment of psychotic depression because of its limited efficacy.1 Thus, combination pharmacotherapy is efficacious for the treatment of psychotic depression. However, evidence is lacking regarding the relative efficacy of antidepressant-antipsychotic combination therapy as compared with monotherapy for maintenance or prevention of relapse.1,2 Some international guidelines for the treatment of psychotic depression suggest monotherapy with an antidepressant as a first-line treatment.2 Presented here is a case of patient with psychotic depression successfully treated with sertraline as monotherapy.

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References

Farahani  A;  Correll  CU:  Are antipsychotics or antidepressants needed for psychotic depression? a systematic review and meta-analysis of trials comparing antidepressant or antipsychotic monotherapy with combination treatment.  J Clin Psychiatry 2012; 73:486–496
[CrossRef] | [PubMed]
 
Leadholm  AK;  Rothschild  AJ;  Nolen  WA  et al:  The treatment of psychotic depression: is there consensus among guidelines and psychiatrists? J Affect Disord 2013; 145:214–220
[CrossRef] | [PubMed]
 
Kishimoto  A;  Todani  A;  Miura  J  et al:  The opposite effects of fluvoxamine and sertraline in the treatment of psychotic major depression: a case report.  Ann Gen Psychiatry 2010; 9:23
 
Kitaichi  Y;  Inoue  T;  Nakagawa  S  et al:  Sertraline increases extracellular levels not only of serotonin, but also of dopamine in the nucleus accumbens and striatum of rats.  Eur J Pharmacol 2010; 647:90–96
[CrossRef] | [PubMed]
 
Dunlop  BW;  Nemeroff  CB:  The role of dopamine in the pathophysiology of depression.  Arch Gen Psychiatry 2007; 64:327–337
[CrossRef] | [PubMed]
 
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