Treatment of Guidelines for Psychotic Depression
First-line
Tricyclic with olanzapine or quetiapine
Second choice
SSRI/SNRI
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Tricyclic with olanzapine or quetiapine
SSRI/SNRI
Ketamine-IV (0.5 mg/kg IV over 40
minutes),
à
rapidly effective, by the anesthetist
High-dose venlafaxine à
200 mg/d,
à
NICE recommended, monitor BP
Electroconvulsive therapy
à effective,
stigmatized
Add risperidone 0.5-3 mg/d,
à
weak evidence, hypotension
Add Triiodothyronine 20–50 μg/d,
à reasonable evidence, monitor
TFTs
Lamotrigine, 100, 200, 400 mg/d,
à best tolerated, risk of rash
SSRI+ buspirone 60 mg/d,
à research-supported, dizziness
at a high dose.
Supportive psychotherapy, CBT, interpersonal therapy, marital/couple therapy, dynamic psychotherapy, behavioral activation
SRI/ Mirtazapine
à A generic SRI; use
mirtazapine if sleep needed
SSRI/non-SRI
à
Most evidence is for a switch to vortioxetine
Mirtazapine, vortioxetine, agomelatine
à if not already trialed
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