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The treatment of refractory major depression, including the psychotic subtype, is
a therapeutic challenge. Three cases of resistant psychotic depression were treated
with clozapine monotherapy, an atypical antipsychotic drug effective in treatment-resistant
schizophrenia and mania. Both psychotic and mood symptoms responded well to clozapine
monotherapy, although response was delayed in one case. Tardive dyskinesia improved
markedly, and tardive dystonia improved moderately in one patient. No patient relapsed
during a follow-up period of 4–6 years of clozapine treatment. Clozapine was well-tolerated
with few side effects. These observations suggest controlled trials of clozapine in
the treatment of psychotic depression that fails to respond to electroconvulsive therapy
or typical neuroleptics plus tricyclic antidepressants are indicated. The same is
true for the use of clozapine in maintenance treatment for psychotic depression in
those cases in which typical neuroleptic drugs are required, in order to reduce the
risk of tardive dyskinesia and dystonia.
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Article info
Publication history
Received in revised form:
June 5,
1995
Received:
August 16,
1994
Footnotes
The research reported was supported in part by USPHS MH 41684, and grants from the Elisabeth Severance Prentiss, and John Pascal Sawyer Foundations. H.Y.M. is the recipient of a USPHS Research Career Scientist Award MH 47808.
The secretarial assistance of Mesdames Diane Mack and Lee Mason is greatly appreciated.
Identification
Copyright
© 1996 Society of Biological Psychiatry. Published by Elsevier Inc.
