Background
Abnormalities in the hypothalamic pituitary adrenal axis have been implicated in the
pathophysiology of psychotic major depression (PMD). Recent studies have suggested
that the antiglucocorticoid, mifepristone might have a role in the treatment of PMD.
The current study tested the efficacy of mifepristone treatment of the psychotic symptoms
of PMD.
Methods
221 patients, aged 19 to 75 years, who met DSM-IV and SCID criteria for PMD and were
not receiving antidepressants or antipsychotics, participated in a double blind, randomized,
placebo controlled study. Patients were randomly assigned to either 7 days of mifepristone
(n = 105) or placebo (n = 116) followed by 21 days of usual treatment.
Results
Patients treated with mifepristone were significantly more likely to achieve response,
defined as a 30% reduction in the Brief Psychiatric Rating Scale (BPRS). In addition,
mifepristone treated patients were significantly more likely to achieve a 50% reduction
in the BPRS Positive Symptom Scale (PSS). No significant differences were observed
on measures of depression.
Conclusion
A seven day course of mifepristone followed by usual treatment appears to be effective
and well tolerated in the treatment of psychosis in PMD. This study suggests that
the antiglucocorticoid, mifepristone, might represent an alternative to traditional
treatments of psychosis in psychotic depression.
Key Words
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Article info
Publication history
Published online: August 10, 2006
Accepted:
May 25,
2006
Received in revised form:
May 3,
2006
Received:
December 9,
2005
Identification
Copyright
© 2006 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
