Sertraline as Monotherapy in the Treatment of Psychotic and Nonpsychotic Depression
J Clin Psychiatry 2003;64:959-965
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Previous studies suggest that
selective serotonin reuptake inhibitors (SSRIs) are effective
when used alone in the treatment of unipolar depression with
psychotic features. The purpose of the present study was to
examine the response to sertraline for patients with and without
psychotic features using standard criteria such as recovery and
Method: An 8-week open-label trial of sertraline
in depressed inpatients was conducted. Twenty-five subjects had
DSM-IV major depressive disorder with psychotic features, and 25
had DSM-IV major depressive disorder without psychotic features.
After a 1-week open washout, all subjects were rated using the
Hamilton Rating Scale for Depression (HAM-D) and Brief
Psychiatric Rating Scale (BPRS) at baseline. The HAM-D was
administered weekly, and the BPRS was administered again only at
the end of the 8-week trial. Medication dosage was started at 50
mg/day, increased to 100 mg/day after 1 week, and then increased
up to 200 mg/day if subjects had not remitted.
Results: Depressed patients without psychosis
responded significantly better than did depressed patients with
psychosis using the criteria of remission (HAM-D score <= 7; p
= .001), response (HAM-D score <= 50% of baseline score; p =
.011), referral for electroconvulsive therapy (HAM-D score >=
15; p = .011), or change in HAM-D scores (p = .016). Baseline
HAM-D score and psychosis independently predicted response,
whereas baseline BPRS scores did not, regardless of whether
psychotic status was entered into the analyses.
Conclusion: Psychotic depression responds
more poorly than depression without psychosis to sertraline
alone. Psychosis was a predictor of response independent of
degree of depression and general psychopathology. Limitations due
to an open-label design are discussed, as are differences between
this study and others using SSRIs for psychotic depression.