Background: The optimal pharmacological treatment of unipolar psychotic depression is uncertain.
Aims: To compare the clinical effectiveness of pharmacological treatments for patients with unipolar psychotic depression.
Method: Systematic review and meta-analysis of randomised controlled trials.
Results: Ten trials were included in the review. We found no evidence that the combination of an antidepressant with an antipsychotic is more effective than an antidepressant alone. This combination was statistically more effective than an antipsychotic alone.
Conclusions: Antidepressant monotherapy and adding an antipsychotic if the patient does not respond, or starting with the combination of an antidepressant and an antipsychotic, both appear to be appropriate options for patients with unipolar psychotic depression. However, clinically the balance between risks and benefits may suggest the first option should be preferred for many patients. Starting with an antipsychotic alone appears to be inadequate.