An 8-Week Open-Label Trial of a 6-Day Course of Mifepristone for the Treatment of Psychotic Depression
J Clin Psychiatry 2005;66(5):598-602
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Objective: Several investigations suggest that
mifepristone leads to the rapid amelioration of psychotic
depression. However, these studies were of short duration (1 week
or less) and included subjects who were taking other psychotropic
medications. The goals of this study were to extend these
findings by conducting an 8-week trial of mifepristone for
subjects with psychotic depression who were taking no concomitant
Method: Twenty subjects with a DSM-IV major
depressive episode with psychotic features (for convenience we
use the term psychotic depression) taking no psychotropic
medications were given a 6-day course of mifepristone and
followed as inpatients for a total of 8 weeks. Nonblinded ratings
using the Hamilton Rating Scale for Depression (HAM-D) and
Clinical Global Impressions scale (CGI) were performed at
baseline and at the end of weeks 1, 4, and 8. The Brief
Psychiatric Rating Scale (BPRS) was also administered at baseline
and after weeks 4 and 8. Subjects were recruited between February
2003 and December 2003.
Results: Significant improvements in HAM-D and
CGI scores were shown after 1 week and between weeks 1 and 4 but
not between weeks 4 and 8. BPRS scores improved significantly
after week 4, while the improvement in BPRS scores between weeks
4 and 8 was of borderline significance.
Conclusion: Mifepristone appears to be a useful
intervention for psychotic depression, leading to significant
improvements even after a 1-week course of administration. Issues
related to its optimal dosing and to prediction of response are
discussed, as are the implications of lack of a placebo group and
the use of nonblinded ratings in the present study.