Posted by Mr. SadPuppyDog on October 9, 2002, at 14:01:00
It is beginning to look like that psychotic depression is very different from other psychotic disorders. Primarily a mood disorder, but with psychotic features it has traditionally been treated with either anti-psychotic drugs and antidepressants. Or with bilateral ECT. ECT is by far the most effective treatment for mood disorders with psychotic features, however there are many pitfalls and obstances to getting ECT. ECT is increasingly scarce and hard to get in many areas of the country. Additionally, both patients and psychiatrists alike seem afraid to do ECT, even when conditions for it are clearly met.
Using atypical anti-psycotic drugs may not be the best approach for psychotic depression. Because studies have shown that mood disordered individuals are at greater risks for EPS and other neuroleptic induced movement disorders than are schizophrenics. So the psychotic depressive is left between a rock and a hard place, with no real truly good treatment available.
A possible solution on the horizon might be the use of steroid antagnoist drugs. It is beginning to look like the HPA axis of psychotically depressed persons is severely out of whack, due to high levels of cortisol. New drugs being developed might be tailor made for this subtype of severe depression. Maybe in the future psychotic depressives would be able to bypass conventional neurolpetics, instead using steroid antagonists combined with an antidepressant. I would think this combo would eliminate all chances of a movement disorder, such as EPS.
here is a website that details exploration of this avenue in science:
http://www2.swmed.edu/psychoendo/psychoticD.htm
Treatment of Major Depressive Disorder with Psychotic Features
Purpose of the Study
This is a multi-center study to determine if a glucocorticoid antagonist is effective for major depressive disorder with psychotic features (hallucinations, delusional beliefs, disorganized thought processes).
Why is this important?
Major depressive disorder with psychotic features (psychotic depression) is frequently associated with high levels in the blood of a hormone called cortisol. This study will examine if a medication which blocks the receptor for cortisol helps reduce symptoms of the illness.
The Study
This is a 7-day inpatient study in which participants receive the study medication or placebo in addition to their current regimen of medications (if any). Psychiatric assessments and several blood samples are required. At the end of the 7-day period, participants will be discharged from the hospital and have 3 additional outpatient follow-ups 1 week, 3 weeks, and 7 weeks after discharge. Participants will be paid.
If you are interested in helping us learn more about corticosteroids and depression and would like to participate in this study, contact us by calling 214-645-8133, via e-mail at dorothy.gleason@utsouthwestern.edu or you can fill out the following form.
poster:Mr. SadPuppyDog
thread:122929
URL: http://www.dr-bob.org/babble/20021006/msgs/122929.html