Challenges in the Treatment of Major Depressive Disorder With Psychotic Features

Anthony J. Rothschild


Schizophr Bull. 2013;39(4):787-796. 

In This Article

Missed Diagnosis of Psychotic Depression

Data from the National Institute of Mental Health (NIMH) Study of the Pharmacotherapy of Psychotic Depression (STOP-PD)[2] indicates that clinicians frequently miss the diagnosis of psychotic depression, in large part, due to a lack of recognition of the psychotic features. In the STOP-PD Study, 27% of 130 diagnoses among a well-characterized sample of patients with a research diagnosis of psychotic depression were initially incorrectly diagnosed. It is likely that the missed diagnosis rate observed in this study was a conservative estimate of the rate in the general clinical population because patients with comorbid conditions such as a history of substance abuse in the past 3 months or unstable medical conditions were excluded. Psychotic depression was most commonly misdiagnosed as major depressive disorder without psychotic features, depression not otherwise specified (NOS), or mood disorder NOS. It was quite striking that none of the patients with missed diagnoses were considered to have a psychotic disorder. This finding suggests that the clinicians were missing the psychosis rather than the mood disorder.