Literature reviews have suggested that combination antidepressant/antipsychotic drug therapy and electroconvulsive therapy (ECT) are of comparable efficacy in treating psychotic depression, and distinctly superior to antidepressant alone or antipsychotic alone. We undertook a meta-analysis of 44 studies, and focussed on those three principal treatment options. There was a trend for ECT to be superior to combination drug therapy, with bilateral ECT being suggested as distinctly more effective than unilateral, and ECT was demonstrated to be significantly superior to tricyclic drug alone. Combination drug therapy ranked as more effective than antipsychotic alone and than antidepressant alone, but that greater efficacy was not significant.