Challenges in the Treatment of Major Depressive Disorder With Psychotic Features

Anthony J. Rothschild


Schizophr Bull. 2013;39(4):787-796. 

In This Article

Epidemiological Studies

Epidemiological studies of the prevalence of psychotic depression in the community indicate that it afflicts approximately 4 per 1 000 people in the general population although the community rates in people over the age of 60 have been reported to be between 14 and 30 per 1 000.[12,13] In a study of 18 980 people aged 15–100 years who were representative of the general populations of several European countries, the prevalence of psychotic depression was 4 per 1 000 people.[14]

In samples of patients with major depression, the rates of psychotic depression are considerably higher. In a European study of patients who met criteria for major depression, 18.5% of them also fulfilled criteria for major depressive episode with psychotic features.[14] In the United States, in the Epidemiologic Catchment Area Study,[15] 14.7% of patients who met criteria for major depression had a history of psychotic features.

In studies of patients with major depression in an inpatient setting, the prevalence rate of psychotic depression is even higher. In a study of consecutively admitted patients hospitalized for major depression, Coryell and colleagues[16] reported that 25% of the patients met criteria for psychotic depression. In samples of older inpatients with major depression, the prevalence of psychotic depression increases dramatically. Studies have found that the frequency of psychotic depression in people over age 60 in inpatient settings varies between 24% and 53%.[17]